Sanefuji H, Adachi H, Baba K, Oda S, Nakata H, Hayashi M
J UOEH. 1984 Mar 1;6(1):75-86. doi: 10.7888/juoeh.6.75.
Presented is an autopsy case of a 79 year-old male who died of miliary tuberculosis. The patient was admitted to the University Hospital with an unknown fever and suspicion of leukemia. He expired on the 13th day of hospitalization. Postmortem examination revealed generalized miliary tuberculosis. The diagnosis of tuberculosis was established only after autopsy. Difficulty in diagnosis of miliary tuberculosis is discussed. Also discussed is a probable association of acute interstitial nephritis with chemotherapy or miliary tuberculosis. Leukemoid reaction is thought to be associated with miliary tuberculosis. The present case reminds us that miliary tuberculosis should never be forgotten when treating a patient having a fever of unknown origin. Cases with tuberculosis were compiled from the Annual of Pathological Autopsy Cases in Japan during 1974 through 1981. There were 3,242 cases of tuberculosis (1.4%) out of 235,095 autopsies recorded in the Annual of Pathological Autopsy Cases in Japan during the above 8 years. Of 3,242 cases 618 were miliary tuberculosis. The latter figure indicates 19.0% of all tuberculosis and 0.26% of all autopsies. Although all age groups were not spared, the 7th and 8th decades were more affected than the others. Tuberculosis has markedly declined since the advent of antituberculous antibiotics. But, autopsy cases with tuberculosis have not recently decreased in number. Clearly, increased awareness of the continuing presence of tuberculosis is needed.
本文介绍了一例79岁男性因粟粒性肺结核死亡的尸检病例。该患者因不明原因发热并怀疑患有白血病入住大学医院。他在住院第13天死亡。尸检发现全身粟粒性肺结核。直到尸检后才确诊为肺结核。文中讨论了粟粒性肺结核的诊断困难。还讨论了急性间质性肾炎与化疗或粟粒性肺结核之间可能存在的关联。类白血病反应被认为与粟粒性肺结核有关。本病例提醒我们，在治疗不明原因发热的患者时，绝不能忘记粟粒性肺结核。肺结核病例取自1974年至1981年日本病理尸检病例年鉴。在上述8年的日本病理尸检病例年鉴记录的235,095例尸检中，有3242例肺结核（占1.4%）。在3242例病例中，618例为粟粒性肺结核。后一数字表明占所有肺结核的19.0%，占所有尸检的0.26%。虽然所有年龄组都未能幸免，但第7和第8个十年比其他年龄组受影响更大。自从抗结核抗生素问世以来，肺结核已明显减少。但是，最近肺结核尸检病例的数量并未减少。显然，需要提高对肺结核持续存在的认识。
