Yamamoto Jun, Shimanouchi Masaoki, Ueda Yoshiaki, Hashizume Toshinori, Suito Tetsushi
Department of Thoracic Surgery, National Hospital Organization, Ibarakihigashi National Hospital, Ibaraki, Japan.
Kyobu Geka. 2013 Aug;66(9):795-7.
A 75-year-old woman who had been treated for pulmonary Mycobacterium intracellulare infection was admitted to a nearby hospital because of hemoptysis, right pneumothorax, and empyema. She had been treated by thoracic drainage and pleural lavage, but was reffered to our hospital because of refractory empyema. Her chest radiograph and chest computed tomography( CT) showed right chronic empyema of which pleural aspirate was smear positive for acid-fast bacilli and positive for the polymerase chain reaction method(PCR)-Mycobacterium intracellulare. Serum levels of white blood cell and C-reactive protein(CRP) were found to be slightly elevated. She was treated with combined use of ethambutol, rifampicin, clarithromycin, and kanamycin and with pleural curettage by thoracoscopic surgery. After surgery additional treatment was done using urokinase which was administered into the thoracic cavity via an thoracic tube. Chronic empyema gradually improved with the treatment and the pleural effusion became bacterial free, enabling the patient to discharge from hospital without thoracic drainage.
一名曾接受过肺细胞内分枝杆菌感染治疗的75岁女性因咯血、右气胸和脓胸入住附近医院。她接受了胸腔引流和胸腔灌洗治疗，但因难治性脓胸被转诊至我院。她的胸部X光片和胸部计算机断层扫描（CT）显示为右慢性脓胸，胸腔穿刺抽吸物涂片抗酸杆菌阳性，聚合酶链反应法（PCR）检测细胞内分枝杆菌呈阳性。发现血清白细胞和C反应蛋白（CRP）水平略有升高。她接受了乙胺丁醇、利福平、克拉霉素和卡那霉素联合治疗，并通过胸腔镜手术进行了胸膜刮除术。术后通过胸腔引流管向胸腔内注入尿激酶进行进一步治疗。经过治疗，慢性脓胸逐渐改善，胸腔积液细菌培养转阴，患者无需胸腔引流即可出院。
