Kohagura N, Yara S, Oyama T, Miyagi H, Higa F, Inadome J, Fukuhara H, Saito A
First Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus.
Kansenshogaku Zasshi. 1994 Jul;68(7):932-6. doi: 10.11150/kansenshogakuzasshi1970.68.932.
A 51-year-old male was admitted because of cough and high fever. His chest X-ray and CT revealed miliary shadows, he was administered some antibiotics. But on the 8th day, his chest X-ray revealed ground glass shadows and he was under severe hypoxemia. We suspected miliary tuberculosis with acute respiratory failure due to his clinical course. The intensive therapy with antituberculosis drugs, hydrocortisone (1 g/day) was started and intubation was performed. The smear of the clinical samples did not show acid-fast bacilli on admission. However, by the polymerase chain reaction amplification method specific DNA fragments of Mycobacterium tuberculosis complex were detected from BALF and bone marrow. He was extubated after the 13th day and he recovered. It is difficult to separate and identify tubercle bacilli rapidly, but PCR is available for early diagnosis.
一名51岁男性因咳嗽和高热入院。他的胸部X线和CT显示粟粒状阴影，给予了一些抗生素治疗。但在第8天，他的胸部X线显示磨玻璃影，且出现严重低氧血症。鉴于他的临床病程，我们怀疑是粟粒性肺结核伴急性呼吸衰竭。开始使用抗结核药物、氢化可的松（1克/天）进行强化治疗，并进行了插管。入院时临床样本涂片未显示抗酸杆菌。然而，通过聚合酶链反应扩增法，从支气管肺泡灌洗（BALF）液和骨髓中检测到结核分枝杆菌复合群的特异性DNA片段。第13天后他拔除了气管插管并康复。快速分离和鉴定结核杆菌很困难，但聚合酶链反应可用于早期诊断。
