Ushiki Atsuhito, Yamazaki Yoshitaka, Ideura Gen, Shinbo Takashi, Sugawara Mariko, Hama Mineyuki, Hanaoka Masayuki
The First Department of of Internal Medicine, Shinshu University School of Medicine, Japan.
Intern Med. 2014;53(8):913-6. doi: 10.2169/internalmedicine.53.1880. Epub 2014 Apr 15.
A 14-year-old girl underwent a medical checkup for Mycobacterium tuberculosis infection because her grandmother had been diagnosed with pulmonary tuberculosis three months earlier. The interferon-gamma release assay (IGRA) showed a positive result. The patient's chest X-ray findings were normal. Chest computed tomography (CT) showed a single mass lesion in the right lower lobe of the lung. A sputum smear of acid-fast bacilli was positive; however, the polymerase chain reaction results for tuberculosis were negative. We diagnosed the patient with pulmonary tuberculosis based on the fact that she had come in contact with a tuberculosis patient. Six weeks later, a liquid culture examination for acid-fast bacilli was found to be positive and the acid-fast bacillus was identified as M. tuberculosis. The use of chest CT is not routinely recommended in all children suspected of having M. tuberculosis infection. However, IGRA-positive children who report frequent contact with infected individuals should undergo CT tomography if chest X-rays do not show any abnormal shadows.
一名14岁女孩因三个月前她的祖母被诊断出患有肺结核而接受了结核分枝杆菌感染的医学检查。干扰素-γ释放试验（IGRA）结果呈阳性。患者的胸部X光检查结果正常。胸部计算机断层扫描（CT）显示右肺下叶有一个单一的肿块病变。痰涂片抗酸杆菌呈阳性；然而，结核的聚合酶链反应结果为阴性。基于她曾接触过一名结核病患者这一事实，我们诊断该患者患有肺结核。六周后，抗酸杆菌液体培养检查结果呈阳性，且抗酸杆菌被鉴定为结核分枝杆菌。并非常规建议对所有疑似结核分枝杆菌感染的儿童进行胸部CT检查。然而，报告经常接触感染者的IGRA阳性儿童，如果胸部X光未显示任何异常阴影，则应进行CT断层扫描。
