Koda Keigo, Enomoto Yasunori, Omae Minako, Akahori Daisuke, Abe Takefumi, Hasegawa Hirotsugu, Matsui Takashi, Yokomura Koshi, Suda Takafumi
Kekkaku. 2016 Feb;91(2):59-63.
An 86-year-old woman with severe dementia had been treated with oral prednisolone at 2 mg/day for autoimmune bullous dermatosis for several years. One year ago, she referred to our hospital due to an ulcerative skin lesion over the right tibial tuberosity. The lesion was treated by an iodine-containing ointment, but did not heal. Subsequently, a new skin lesion appeared in the right popliteal fossa. One month ago, the patient had increased sputum production that was accompanied by fever, anorexia, and dyspnea; consequently, she visited our department. Chest computed tomography revealed diffuse micronodules with ground-glass attenuation. Acid-fast bacteria staining of the sputum was positive and the polymerase chain reaction detected Mycobacterium tuberculosis. In addition, the bacilli were also found in the skin lesions of the right limb. Therefore, a diagnosis of cutaneous, and miliary tuberculosis was made. Although the anti-tuberculous combination chemotherapy consisting of isoniazid, rifampicin, and ethambutol was immediately initiated, her condition did not improve. She died on day 19 of hospitalization. Drug susceptibility testing revealed no resistance to all the three drugs; hence, it was concluded that the time-delay in diagnosis of cutaneous tuberculosis lead to the progression to miliary tuberculosis and subsequent death.
一名86岁的重度痴呆女性因自身免疫性大疱性皮肤病，已口服泼尼松龙2毫克/天治疗数年。一年前，她因右胫骨结节处出现溃疡性皮肤病变前来我院就诊。该病变用含碘软膏治疗，但未愈合。随后，右腘窝出现了新的皮肤病变。一个月前，患者痰液增多，并伴有发热、厌食和呼吸困难，因此前来我科就诊。胸部计算机断层扫描显示弥漫性微结节伴磨玻璃样密度影。痰液抗酸杆菌染色呈阳性，聚合酶链反应检测到结核分枝杆菌。此外，在右下肢皮肤病变中也发现了杆菌。因此，诊断为皮肤粟粒性结核。尽管立即开始了由异烟肼、利福平、乙胺丁醇组成的抗结核联合化疗，但她的病情并未改善。她于住院第19天死亡。药敏试验显示对这三种药物均无耐药性；因此，得出结论，皮肤结核诊断延迟导致病情进展为粟粒性结核并最终死亡。
