Montoliu J, Gatell J M, Bonal J, Miró J M, López-Pedret J, Revert L
Am J Nephrol. 1985;5(3):205-11. doi: 10.1159/000166935.
A 28-year-old patient with chronic renal failure on maintenance hemodialysis developed fever, granulomatous hepatitis, pulmonary infiltrates, sacroiliitis, and spondylitis which were unresponsive to conventional antituberculous treatment. Cultures of the sputum gave repeated growth of Mycobacterium fortuitum. This organism was resistant 'in vitro' to most antituberculous drugs and sensitive to some aminoglycosides and doxycycline. No mycobacteria were found in the water used for dialysis. The patient was successfully treated with amikacin and doxycycline. Nontuberculous mycobacterial infection should be considered in the differential diagnosis of febrile illnesses resembling tuberculosis in hemodialysis patients. Defective immune mechanisms could contribute to this complication. Since M. fortuitum is usually resistant to antituberculous drugs, precise identification and sensitivity testing are essential for optimal management.
一名28岁维持性血液透析的慢性肾衰竭患者出现发热、肉芽肿性肝炎、肺部浸润、骶髂关节炎和脊柱炎，对传统抗结核治疗无反应。痰培养多次培养出偶然分枝杆菌。该菌在体外对大多数抗结核药物耐药，对一些氨基糖苷类药物和强力霉素敏感。透析用水中未发现分枝杆菌。患者用阿米卡星和强力霉素成功治疗。在血液透析患者中，类似结核病的发热性疾病的鉴别诊断应考虑非结核分枝杆菌感染。免疫机制缺陷可能导致这种并发症。由于偶然分枝杆菌通常对抗结核药物耐药，精确鉴定和药敏试验对最佳治疗至关重要。
