Ohse H, Saito T, Kadono K, Hirano K, Watanabe S, Nemoto E, Fukai S, Yanai N, Ishii Y, Hasegawa S
National Seiranso Hospital, Ibaraki, Japan.
Kekkaku. 1997 Feb;72(2):73-7.
A 46-year old man was admitted to a hospital because of cough and dyspnea. He was diagnosed as interstitial pneumonia and was treated with prednisolone (PSL) and antibiotics. The symptoms improved temporarily but he soon developed acute respiratory failure and was transferred to our hospital. Chest X-ray and CT revealed ground-glass opacities in both lung fields. He was treated with methyl PSL, antibiotics, and antimycobacterial drugs but he died on the fourth hospital day. Retrospectively, hematologic laboratory examinations revealed that CD4+ cell count was 0/microliter and serological tests for HIV were positive by both EIA and Western blot methods. The culture of the bone marrow specimens was positive for mycobacteria other than M. tuberculosis, and the bacilli were identified as Mycobacterium avium. Thus, his disease was eventually diagnosed as disseminated Mycobacterium avium complex (MAC) infection. In the past reports, the diagnosis of disseminated MAC infection was most often made by blood cultures, however, the isolation of MAC from bone marrow is another sensitive and specific method for the diagnosis of this infection. In some cases, bone marrow examination would be useful to diagnose disseminated MAC infection.
一名46岁男性因咳嗽和呼吸困难入院。他被诊断为间质性肺炎，并接受了泼尼松龙（PSL）和抗生素治疗。症状暂时改善，但他很快发展为急性呼吸衰竭，随后被转至我院。胸部X线和CT显示双肺野磨玻璃样阴影。他接受了甲泼尼龙、抗生素和抗分枝杆菌药物治疗，但在住院第四天死亡。回顾性分析，血液学实验室检查显示CD4 +细胞计数为0/微升，HIV血清学检测通过酶免疫分析（EIA）和免疫印迹法均为阳性。骨髓标本培养出非结核分枝杆菌，鉴定为鸟分枝杆菌。因此，他的疾病最终被诊断为播散性鸟分枝杆菌复合体（MAC）感染。在过去的报道中，播散性MAC感染的诊断大多通过血培养做出，然而，从骨髓中分离出MAC是诊断这种感染的另一种敏感且特异的方法。在某些情况下，骨髓检查对诊断播散性MAC感染是有用的。
