Ogasawara T, Senda Y, Totani Y, Suzuki M, Ooshika H, Maeda H, Hattori N, Abe T
Department of Respiratory Disease, Nagoya Daini Red Cross Hospital, Japan.
Kekkaku. 1995 Apr;70(4):307-11.
A case of pulmonary tuberculosis manifested as infected bulla complicating with tuberculous pneumonia is reported. A 63-year-old male visited our hospital because of chest X-ray abnormality detected by his home doctor. He complained of pyrexia and productive cough. Chest X-ray showed large bulla with air-fluid level, associated with surrounding infiltration at right upper lobe. On the diagnosis of infected bulla empirical antibiotic therapy was started on out-patient basis and continued after admission, but chest X-ray findings worsened, although subjective symptoms were once relieved. Surgical intervention was recommended, but after short interval pulmonary infiltrates rapidly worsened and expanded to other lobes. Sputum was reexamined and Mycobacterium, later proved as Mycobacterium tuberculosis with DNA probe method, was detected in the sputum specimen. Anti-mycobacterial drugs were administered and subjective symptoms, laboratory, and chest X-ray findings improved. Infected bulla caused by Mycobacterium tuberculosis is rare, but when it is resistant to common empirical therapy, Mycobacterium tuberculosis should be considered as one of its causative agents.
报告了一例表现为感染性肺大疱合并结核性肺炎的肺结核病例。一名63岁男性因家庭医生检查发现胸部X线异常前来我院就诊。他主诉发热和咳痰。胸部X线显示右上叶有含气液平面的大肺大疱，并伴有周围浸润。在诊断为感染性肺大疱后，门诊开始经验性抗生素治疗，并在入院后继续，但尽管主观症状曾一度缓解，胸部X线表现却恶化了。建议进行手术干预，但短时间后肺部浸润迅速恶化并蔓延至其他肺叶。重新检查痰液，在痰标本中检测到分枝杆菌，后来通过DNA探针法证实为结核分枝杆菌。给予抗分枝杆菌药物治疗后，主观症状、实验室检查及胸部X线表现均有所改善。结核分枝杆菌引起的感染性肺大疱很少见，但当它对常见的经验性治疗耐药时，应将结核分枝杆菌视为其病因之一。
