Division of Infectious Diseases and Infection Control, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
Division of Pharmacy, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
Am J Case Rep. 2022 Oct 10;23:e937485. doi: 10.12659/AJCR.937485.
BACKGROUND Mycobacterium tuberculosis (M. tuberculosis) is usually treated by oral antimycobacterial agents, including rifampicin, ethambutol, and pyrazinamide, but the treatment regimen with intravenous and/or intramuscular antimycobacterial agents for patients who cannot take medications orally remains unclear. CASE REPORT A 77-year-old man with chronic renal failure had an esophageal-skin fistula after he had surgeries for removal of esophageal and gastric cancers and reconstruction using jejunum, and he showed a cavity, tree-in-bud formation, and pleural effusions in his left upper lung fields on his chest X-ray after treatment of cellulitis and bacteremia/candidemia by meropenem, teicoplanin, and micafungin. M. tuberculosis was isolated from his sputum and exudate fluid from the reconstructed esophageal-skin fistula. Although he could not take antimycobacterial agents orally, treatment was started with intravenous agents combining levofloxacin (LVFX) every other day, isoniazid (INH), and linezolid (LZD). However, his platelets were decreased 21 days after treatment started, and it was thought to be an adverse effect of LZD and/or INH. After changing LZD to tedizolid (TZD), in addition to changing from INH to intramuscular streptomycin twice per week, his platelet counts increased. Intravenous TZD could be continued, and it maintained his condition without exacerbations of thrombocytopenia and renal failure. The M. tuberculosis disappeared, and the abnormal chest X-ray shadows were improved 2 months after the start of treatment. CONCLUSIONS Administration of intravenous TZD, in addition to intravenous LVFX and intramuscular SM in combination, might be a candidate regimen for M. tuberculosis patients who cannot take oral medications.
分枝杆菌(M. tuberculosis)通常通过口服抗分枝杆菌药物治疗,包括利福平、乙胺丁醇和吡嗪酰胺,但对于不能口服药物的患者,静脉和/或肌肉内抗分枝杆菌药物的治疗方案仍不清楚。
一名 77 岁男性因慢性肾衰竭,在接受食管癌和胃癌切除及空肠重建手术后出现食管-皮肤瘘管,在使用美罗培南、替考拉宁和米卡芬净治疗蜂窝织炎和菌血症/念珠菌血症后,其胸部 X 射线显示左肺上叶出现空洞、树芽征和胸腔积液。从他的痰液和重建食管-皮肤瘘管的渗出液中分离出分枝杆菌。尽管他不能口服抗分枝杆菌药物,但仍开始使用左氧氟沙星(LVFX)每两天一次、异烟肼(INH)和利奈唑胺(LZD)联合静脉注射药物进行治疗。然而,在开始治疗 21 天后,他的血小板减少,考虑为 LZD 和/或 INH 的不良反应。在将 LZD 替换为替比培南(TZD)后,除了将 INH 替换为每周两次肌肉内链霉素外,他的血小板计数增加。静脉 TZD 可以继续使用,并且它维持了他的病情,没有血小板减少症和肾衰竭恶化。分枝杆菌消失,治疗开始后 2 个月,异常的胸部 X 射线阴影得到改善。
静脉注射 TZD 联合静脉注射 LVFX 和肌肉内 SM 可能是不能口服药物的分枝杆菌患者的候选治疗方案。