Fujishima Nobuhiro, Komiya Kosaku, Matsunaga Naoko, Usagawa Yuko, Yamasue Mari, Hashinaga Kazuhiko, Umeki Kenji, Nureki Shin-Ichi, Ando Masaru, Matsunaga Terufumi, Kadota Jun-Ichi
Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan.
Internal Medicine, Matsunaga Cardiovascular Hospital, Japan.
Intern Med. 2019;58(2):263-266. doi: 10.2169/internalmedicine.1369-18. Epub 2018 Jan 15.
Tosufloxacin, which is not used to treat Mycobacterium tuberculosis, is a fluoroquinolone recommended for pneumonia when the possibility of tuberculosis infection cannot be excluded. In the present case, symptoms and chest infiltrative shadow initially improved by tosufloxacin. Therefore, we regarded this patient as having general pneumonia and did not perform follow-up chest X-ray until the infiltrates had completely disappeared. However, a few weeks later, the symptoms and the infiltrates had worsened, so M. tuberculosis was isolated from the patient's sputum. This case suggests that patients suspected of having pulmonary tuberculosis should be monitored carefully, even if antibiotics without antituberculous activity are initially effective.
托氟沙星不用于治疗结核分枝杆菌,是一种在不能排除结核感染可能性时推荐用于肺炎治疗的氟喹诺酮类药物。在本病例中,托氟沙星治疗后症状和胸部浸润影最初有所改善。因此,我们认为该患者患有普通肺炎,在浸润影完全消失之前未进行胸部X线复查。然而,几周后,症状和浸润影加重,从患者痰液中分离出结核分枝杆菌。该病例提示,即使最初使用无抗结核活性的抗生素有效,对疑似肺结核的患者也应仔细监测。