Takakura S, Tanaka E, Kimoto T, Watanabe I, Matsumoto H, Tsuyuguchi K, Niimi A, Suzuki K, Amitani R, Kuze F
Department of Pulmonary Medicine, Kobe City General Hospital, Japan.
Kekkaku. 1998 Oct;73(10):591-7.
A 52-year-old woman with visual loss of her left eye consulted a ophthalmology clinic. She was conducted left vitrectomy and administered corticosteroid under the diagnosis of uveitis of unknown cause. But her visual acuity was not improved. Although re-surgery was planned, pus retention was found in her left eye. After her left eye was resected, fever and general malaise appeared suddenly. Her chest X-ray film revealed diffuse micronodular opacities. Acid-fast bacilli were detected from her sputum and identified to be Mycobacterium tuberculosis. She was diagnosed miliary tuberculosis, and then antituberculous chemotherapy consisting of 4 drugs was started. Granulomatous inflammation destructing retina and numerous acid-fact bacilli were found in histologic examination of the resected eye. This case was thought to be miliary tuberculosis disseminated from intraocular tuberculosis. After 2 months of therapy, neurologic symptoms which might be caused by brain tuberucloma appeared and deteriorated rapidly. But by adding corticosteroid to antituberculous therapy, symptoms were diminished gradually.
一名52岁左眼视力丧失的女性前往眼科诊所就诊。在被诊断为不明原因葡萄膜炎后，她接受了左眼玻璃体切除术并使用了皮质类固醇。但她的视力并未改善。尽管计划再次手术，但在她的左眼中发现了脓液潴留。切除左眼后，她突然出现发热和全身不适。她的胸部X光片显示弥漫性微小结节状混浊。从她的痰液中检测出抗酸杆菌，鉴定为结核分枝杆菌。她被诊断为粟粒性肺结核，随后开始使用4种药物进行抗结核化疗。在切除眼球的组织学检查中发现了破坏视网膜的肉芽肿性炎症和大量抗酸杆菌。该病例被认为是由眼内结核播散引起的粟粒性肺结核。治疗2个月后，出现了可能由脑结核瘤引起的神经症状，并迅速恶化。但通过在抗结核治疗中加用皮质类固醇，症状逐渐减轻。
