肺結核症に両頸部リンパ節結核および肋骨周囲膿瘍を合併した1例 A CASE OF PULMONARY TUBERCULOSIS COMPLICATED WITH TUBERCULOSIS OF BILATERAL CERVICAL LYMPH NODES AND EXACERBATED PERICOSTAL ABSCESS

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著者

    • 伊藤 祐子 ITO Yuko
    • 国立療養所東名古屋病院呼吸器科 Department of Respiratory Diseases, National Higashi-Nagoya Hospital
    • 須藤 幸雄 SUDO Yukio
    • 国立療養所東名古屋病院呼吸器科 Department of Respiratory Diseases, National Higashi-Nagoya Hospital
    • 小川 賢二 OGAWA Kenji
    • 国立療養所東名古屋病院呼吸器科 Department of Respiratory Diseases, National Higashi-Nagoya Hospital
    • 田野 正夫 TANO Masao
    • 国立療養所東名古屋病院呼吸器科 Department of Respiratory Diseases, National Higashi-Nagoya Hospital

抄録

症例は23歳男性, 入院時ガフキー5号, 病型はわII3の肺結核症であった。入院時よりHREZの4剤にて治療を開始し, PZA (pyrazinamide) は2カ月間で終了した。第51病日より両頸部リンパ節腫脹が出現, 第115病日には, 両側とも小児手挙大にまで腫脹, 穿刺液塗抹で抗酸菌 (1+) であった。<BR>また, 第86病日より左前胸部に鶏卵大の腫脹が出現, 穿刺液塗抹で抗酸菌 (1+) だった。喀痰からの培養菌薬剤感受性試験では耐性を認めなかったが, 第110病日よりethambutol (EB) を中止, HRにstreptomycin (SM), tuberactin (TH) を加え4剤治療を継続した。結局1年間の治療にて肺, 頸部, 前胸部ともに病状は軽快し治療終了となった。リンパ節腫大ならびに肋骨周囲膿瘍は初期悪化ではないかと考えられた。

A 23-year-old man was admitted to our hospital because of cough and sputum in April 2001. A chest roent-genogram revealed infiltrative shadow with cavity formation in the bilateral lung fields. He was treated with sensitive anti-tuberculous drugs. After starting the antituberculous therapy with INH, RFP, EB and PZA, bilateral cervical lymphade-nopathy developed. Three months later, pericostal abscess appeared in the left anterior chest wall. Microscopic examina-tion of the specimen obtained by needle aspiration biopsy disclosed positive for acid-fast bacilli. Smears of the pus showed acidfast bacilli identified as <I>Mycobacterium tubercu-losis</I> by DNA-DNA PCR method. He developed tuberculous bilateral cervical lymphadenopathy and pericostal abscess during the course of antituberculosis chemotherapy. Drug sensitivity test revealed that tubercle bacilli in this case were sensitive. One year after the administration of chemotherapy, cervical lymphadenopathy and pericostal abscess were improved. Both masses were discontinuous with pulmonary tuberculosis and the possibility of lymphogenous spread of organism was speculated as its etiology. We assumed that both masses were due to paradoxical response to the anti-tuberculosis chemotherapy.

収録刊行物

  • 結核

    結核 79(1), 11-15, 2004-01-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

参考文献:  15件中 1-15件 を表示

被引用文献:  1件中 1-1件 を表示

各種コード

  • NII論文ID(NAID)
    10012840820
  • NII書誌ID(NCID)
    AN00073442
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    00229776
  • NDL 記事登録ID
    026778539
  • NDL 請求記号
    Z19-133
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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