Amemiya T, Okabe T, Kibe Y, Mizuhashi K, Fujimura M, Matsuda T
Division of Pulmonary Medicine, Kanazawa National Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Dec;32(12):1181-6.
A 23-year-old man was admitted with a persistent high-grade fever of 20 days duration. Chest roentgenogram showed diffuse miliary shadows in both lung fields, highly suggestive of miliary tuberculosis. Sputum, gastric juice, and bronchoalveolar lavage fluid did not, however, reveal acid-fast bacilli on smears. A bone marrow aspirate and a transbronchial lung biopsy were also negative for caseating granulomas and tubercule bacilli. After admission, the high-grade fever remitted in several days without continuous antibiotic, antituberculosis or antipyretic therapy. Levels of inflammatory markers (CRP, ESR, alpha 2-globulin dropped simultaneously. Despite the atypical clinical course, miliary tuberculosis was suspected. We therefore carried out an open lung biopsy. The presence of caseating granulomas and acid-fast bacilli confirmed the diagnosis of miliary tuberculosis. The remission of miliary tuberculosis without treatment is very rare and the details of this case are presented herein with a discussion of the pertinent literature.
一名23岁男性因持续20天的高热入院。胸部X线片显示双肺野弥漫性粟粒状阴影，高度提示粟粒性肺结核。然而，痰、胃液和支气管肺泡灌洗液涂片均未发现抗酸杆菌。骨髓穿刺和经支气管肺活检也未发现干酪样肉芽肿和结核杆菌。入院后，未经持续抗生素、抗结核或退热治疗，高热在数天内消退。炎症标志物（CRP、ESR、α2球蛋白）水平同时下降。尽管临床过程不典型，但仍怀疑为粟粒性肺结核。因此，我们进行了开胸肺活检。干酪样肉芽肿和抗酸杆菌的存在证实了粟粒性肺结核的诊断。粟粒性肺结核未经治疗而缓解非常罕见，本文介绍了该病例的详细情况并讨论了相关文献。
