Nakao Akira, Ishii Hiroshi, Igata Fumiyasu, Kushima Hisako, Fujita Masaki, Hisano Satoshi, Watanabe Kentaro
Department of Respiratory Medicine, Fukuoka University Hospital, Japan.
Department of Respiratory Medicine, Fukuoka University Hospital, Japan.
J Infect Chemother. 2016 Sep;22(9):638-41. doi: 10.1016/j.jiac.2016.02.002. Epub 2016 Mar 10.
A 66-year-old woman, who had been treated with systemic corticosteroids for four months for vasculitis of unknown etiology, was referred to our department due to a fever, dyspnea and patchy ground-glass opacities on chest computed tomography. As transbronchial biopsy specimens were suggestive of interstitial pneumonia, the prescribed dose of corticosteroids was increased. However, the patient developed pyrexia and presented diffuse ground-glass attenuation in the lungs bilaterally. Antituberculous drugs were administered because a previous blood interferon-gamma release assay was positive, however, the patient died of severe respiratory failure within several days, and cultures of her blood, urine and bone marrow posthumously revealed Mycobacterium tuberculosis. An autopsy revealed multiple foci of air-space pneumonia containing numerous acid-fast bacilli without granuloma formation, accompanied by diffuse alveolar damage. An immunosuppressive condition might inhibit air-space pneumonia to become granulomatous inflammation as an initial stage of pulmonary tuberculosis.
一名66岁女性，因不明病因的血管炎接受了四个月的全身性皮质类固醇治疗，因发热、呼吸困难以及胸部计算机断层扫描显示斑片状磨玻璃影而转诊至我科。经支气管活检标本提示间质性肺炎，遂增加了皮质类固醇的给药剂量。然而，患者出现发热，并在双侧肺部呈现弥漫性磨玻璃样衰减。由于之前的血液干扰素-γ释放试验呈阳性，给予了抗结核药物治疗，然而，患者在数天内死于严重呼吸衰竭，其死后血液、尿液和骨髓培养显示有结核分枝杆菌。尸检发现多个肺泡性肺炎病灶，含有大量抗酸杆菌，无肉芽肿形成，并伴有弥漫性肺泡损伤。免疫抑制状态可能会抑制肺泡性肺炎在肺结核初期发展为肉芽肿性炎症。
