粟粒結核を合併した胸腺腫の1例  [in Japanese] THYMOMA COMPLICATED WITH MILIARY TUBERCULOSIS  [in Japanese]

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Abstract

われわれは粟粒結核を合併した胸腺腫を経験したので報告する。69歳の女性が体重減少, 全身倦怠感と呼吸困難を主訴として近医に入院した。胸部レントゲン写真上, 両側にびまん性粒状影が認められた。骨髄生検, 左咽頭生検の結果, 乾酪壊死を伴った巨細胞を含む肉芽腫が証明された。粟粒結核と診断され, 当院に転院となった。胸部レントゲン写真とCT上, 胸腺腫と思われる縦隔腫瘍が認められ, 両側肺野にはびまん性粒状影が認められた。抗結核療法の後, 拡大胸腺摘出術が行われた。病理学的に胸腺腫と診断した。手術前後で末梢血リンパ球の免疫学的検討を施行した。ツベルクリン反応は術後陰性化した。CD4陽性T細胞が減少し, B細胞とNK細胞に関連した表面マーカーをもつ細胞が増加していた。細胞質内インターフェロンγを有するTh1細胞が減少していた。ツベルクリン反応は術後陰性化したものの, これらの免疫学的異常は手術後3カ月の時点でも続いていた。

We report a case of thymoma complicated with miliary tuberculosis. A 69-year-old woman was admitted to a hospital because of body weight loss, general fatigue, and dyspnea. Chest X-ray showed a small, diffuse granular shadows in both lungs. Biopsiedspecimens from bone marrow and left pharynx revealed granuloma with both giant cells and caseous necrosis. The diagnosis of miliary tuberculosis was made. The patient was then transferred to our hospital. Both chest X-ray and computed tomography conducted on admission revealed a mass in the mediastinum as well as diffuse granular shadows in both lungs. We suspected a presence of thymoma. Antituberculosis therapy was started, and extended thymectomy was performed. The diagnosis of thymoma was confirmed pathologically. Immunological analysis of peripheral blood lymphocytes was done before and after the operation. Negative conversion of PPD reaction was observed after thymectomy. Although the response of peripheral lymphocytes to phytohaemoagglutinin (PHA) and concanavalin A recovered after thymectomy, a marked decrease of the number of CD 4 T cells, a decrease of T helper 1 cells, a slight increase in the number of B cells and cells expressing natural killer cell-related surface markers were observed throughout the course of illness.

Journal

  • Kekkaku(Tuberculosis)

    Kekkaku(Tuberculosis) 77(5), 415-419, 2002-05-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

References:  19

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008879588
  • NII NACSIS-CAT ID (NCID)
    AN00073442
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00229776
  • NDL Article ID
    026779703
  • NDL Call No.
    Z19-133
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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