[Investigation of severe tuberculous pneumonia associated with irreversible exacerbation after intensive antitubercular chemotherapy--with regard to the etiology of initial reversible roentgenographic progression].

We reported 3 cases of severe tuberculous pneumonia associated with irreversible exacerbation and sequential death appeared after each intensive antitubercular chemotherapy containing INH, RFP, EB and SM. Acute tuberculous pneumonia probably represents an exudative hypersensitivity reaction to tuberculoprotein, rather than actual inflammation caused by the Mycobacterium tuberculosis organism. Mechanisms of the reversible roentgenographic progression are considered to be also similar to those of acute tuberculous pneumonia regarding the involvement of an exudative hypersensitivity reaction to tuberculoprotein. Our cases indicate that the involvement of reversible roentgenographic progression in patients with severe tuberculous pneumonia may result in the development of acute respiratory failure or adult respiratory distress syndrome (ARDS), resulting from the acceleration of exudative hypersensitivity reactions by the intensive antitubercular chemotherapy. In the present report, relationships between tuberculous pneumonia, reversible roentgenographic progression and the appearance of acute respiratory failure (or ARDS) were discussed. Furthermore, the use of steroids is discussed.