Naganuma M, Toyoda T, Osumi M, Kanno I, Takasugi T, Kawashiro T, Aoyagi T, Fukuda J
Division of Respiratory Disease, National Higasi-Saitama Hospital, Japan.
Kekkaku. 1996 May;71(5):345-9.
A case is 48 years-old Japanese man who had a history of frequent sexual contact with prostitutes in Thailand and the Philippines. He presented with chief complaint of chest discomfort in April 1995. His chest X-ray film showed right mediastinal lymph node swelling in other hospital and the sputum smear was strongly positive for acid fast bacilli. In May 1995, he was admitted to our hospital and serological tests for HIV were positive both by EIA and Western blot methods. The CD4 lymphocyte count was 167/microliters. He was diagnosed as a case of AIDS according to the criteria proposed by the AIDS surveillance committee of the Japanese Ministry of Health and Welfare. Although numerous tubercule bacilli were detected in sputum, the chest X-ray did not show abnormal shadow in lung fields. So the diagnosis of bronchial tuberculosis was suspected by these apparently contradictory findings and the bronchoscopy was performed. Biopsy specimen of the bronchial mucous membrane obtained by bronchoscopy confirmed the presence of acid fast bacilli by Ziehl-Neelsen's staining method, however, histological findings were atypical of tuberculosis. A month after the initiation of treatment with isoniazid, rifampicin and ethambutol and AZT, his clinical symptoms improved and the sputum smear and the culture tests for tubercule bacilli converted to negative. Complications of AIDS, (Pneumocystis carinii infection, Cytomegalo virus infection, Kaposi's sarcoma, etc) other than tuberculosis have not developed to date. In the past reports, we could not find reports of bronchial tuberculosis with AIDS. Tuberculous granuloma formation was scarce in this case, and it was suspected that bronchial tuberculosis with AIDS would show characteristic sign as same as pulmonary tuberculosis with AIDS.
一名48岁的日本男子，有在泰国和菲律宾与妓女频繁性接触的病史。1995年4月，他因胸部不适为主诉前来就诊。在其他医院，他的胸部X光片显示右纵隔淋巴结肿大，痰涂片抗酸杆菌呈强阳性。1995年5月，他入住我院，通过酶免疫分析（EIA）和免疫印迹法进行的HIV血清学检测均呈阳性。CD4淋巴细胞计数为167/微升。根据日本厚生省艾滋病监测委员会提出的标准，他被诊断为艾滋病病例。尽管在痰中检测到大量结核杆菌，但胸部X光片在肺野未显示异常阴影。因此，根据这些明显矛盾的发现怀疑为支气管结核，并进行了支气管镜检查。通过支气管镜获取的支气管黏膜活检标本经萋-尼染色法证实存在抗酸杆菌，然而，组织学表现并非典型的结核。在开始使用异烟肼、利福平、乙胺丁醇和齐多夫定治疗一个月后，他的临床症状有所改善，痰涂片和结核杆菌培养检测转为阴性。迄今为止，除结核病外，艾滋病的并发症（卡氏肺孢子虫感染、巨细胞病毒感染、卡波西肉瘤等）尚未出现。在过去的报告中，我们未找到艾滋病合并支气管结核的报道。该病例中结核性肉芽肿形成较少，怀疑艾滋病合并支气管结核会表现出与艾滋病合并肺结核相同的特征性表现。
