Yoshitomi A, Ono T, Sato A, Nakamura H, Chida K
Department of Internal Medicine, Kikugawa General Hospital.
Kansenshogaku Zasshi. 1998 May;72(5):561-3. doi: 10.11150/kansenshogakuzasshi1970.72.561.
An asymptomatic 52-year-old male, who was diagnosed as poorly controlled diabetes mellitus (DM), was referred to our hospital because of abnormal shadows on chest X-rays. Physical examinations and laboratory data showed no abnormal findings except increased values of blood sugar and HbA1c (12.1%). Chest X-ray and CT scan revealed multiple nodular shadows in both lung fields. The specimens from transbronchial biopsy showed epithelioid granuloma, and Mycobacterium tuberculosis was confirmed with bronchial wash fluid. The patient was then treated with antimycobacterial drugs and sulfonylurea along with diet therapy. The multiple nodular shadows gradually disappeared. It seemed that impaired host defense mechanisms caused by poorly controlled DM is responsible for the bronchogenic dissemination of M. tuberculosis, resulting in the extension into the multiple nodular shadows. Thus, a good control of DM is important for the prevention of an onset and excerbation of tuberculosis in patients with DM.
一名52岁无症状男性，被诊断为糖尿病控制不佳，因胸部X光片出现异常阴影而转诊至我院。体格检查和实验室检查数据除血糖和糖化血红蛋白（HbA1c）值升高（12.1%）外，未发现异常。胸部X光和CT扫描显示双肺野有多个结节状阴影。经支气管活检标本显示上皮样肉芽肿，支气管灌洗液确诊为结核分枝杆菌。随后该患者接受抗分枝杆菌药物、磺脲类药物治疗及饮食疗法。多个结节状阴影逐渐消失。似乎是糖尿病控制不佳导致宿主防御机制受损，从而引起结核分枝杆菌的支气管播散，导致病变扩展为多个结节状阴影。因此，良好控制糖尿病对于预防糖尿病患者结核病的发生和加重很重要。
