Rajagopala Srinivas, Chandrasekharan Sujatha
Department of Medicine and Medical Intensive Care, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry, Chennai, India ; Department of Microbiology, Global Hospitals and Health City, Perumbakkam, Chennai, India.
Department of Microbiology, Global Hospitals and Health City, Perumbakkam, Chennai, India.
Indian J Crit Care Med. 2015 Jan;19(1):50-2. doi: 10.4103/0972-5229.148650.
We present a young immunocompetent male with diagnosed sputum culture-positive tuberculosis on intensive phase with observed daily four-drug antituberculosis therapy. He presented at 1-month of treatment with sequential bilateral pneumothoraces, increase in cavitation and consolidation and respiratory failure. Repeat smears for acid-fast bacilli had downgraded, and cultures were negative. Quantiferon-GOLD (initially negative) was now strongly positive. A diagnosis of possible immune reconstitution syndrome was considered and 0.25 mg/kg/day oral steroids administered. We also discuss an approach to differential diagnosis of a patient worsening on treatment for microbiologically confirmed tuberculosis in this manuscript.
我们报告了一名年轻的免疫功能正常男性，在强化期痰培养确诊为结核阳性，接受每日观察的四联抗结核治疗。他在治疗1个月时出现了序贯性双侧气胸、空洞和实变增加以及呼吸衰竭。抗酸杆菌重复涂片结果降级，培养为阴性。结核感染T细胞检测（最初为阴性）现在呈强阳性。考虑可能为免疫重建综合征的诊断，并给予0.25mg/kg/天的口服类固醇治疗。我们还在本手稿中讨论了对微生物学确诊的结核病治疗中病情恶化患者的鉴别诊断方法。
