結核性胸膜炎の治療中に対側の胸水をきたし, 慢性呼吸不全となった1症例
症例は74歳男性。微熱を伴う右胸水貯留にて発症。喀痰や胸水の培養では結核菌陰性であったが, 胸膜生検の培養にて結核菌を認めた。治療は, イソニアジド (INH) 300mg/日, リファンピシン (RFP) 600mg/日, ピラジナミド (PZA) 1200mg/日にて施行。一時的には発熱は軽快したが, 1週間後より, 38.0℃以上の発熱をきたし, 化学療法より第17日目の胸部レントゲンにて左胸水貯留を認め, 左胸水検査にてリンパ球浸潤を認めたが, 胸水培養では結核菌は陰性であった。抗結核療法に対する奇異性反応と考え, 3日間の休薬後に, さらにプレドニゾロン投与を追加して初期治療を再開し...
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| Published in | 結核 Vol. 77; no. 7; pp. 527 - 531 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本結核病学会
15.07.2002
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0022-9776 1884-2410 |
| DOI | 10.11400/kekkaku1923.77.527 |
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| Abstract | 症例は74歳男性。微熱を伴う右胸水貯留にて発症。喀痰や胸水の培養では結核菌陰性であったが, 胸膜生検の培養にて結核菌を認めた。治療は, イソニアジド (INH) 300mg/日, リファンピシン (RFP) 600mg/日, ピラジナミド (PZA) 1200mg/日にて施行。一時的には発熱は軽快したが, 1週間後より, 38.0℃以上の発熱をきたし, 化学療法より第17日目の胸部レントゲンにて左胸水貯留を認め, 左胸水検査にてリンパ球浸潤を認めたが, 胸水培養では結核菌は陰性であった。抗結核療法に対する奇異性反応と考え, 3日間の休薬後に, さらにプレドニゾロン投与を追加して初期治療を再開したが, 両側胸水貯留と低酸素血症は持続した。 |
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| AbstractList | 症例は74歳男性。微熱を伴う右胸水貯留にて発症。喀痰や胸水の培養では結核菌陰性であったが, 胸膜生検の培養にて結核菌を認めた。治療は, イソニアジド (INH) 300mg/日, リファンピシン (RFP) 600mg/日, ピラジナミド (PZA) 1200mg/日にて施行。一時的には発熱は軽快したが, 1週間後より, 38.0℃以上の発熱をきたし, 化学療法より第17日目の胸部レントゲンにて左胸水貯留を認め, 左胸水検査にてリンパ球浸潤を認めたが, 胸水培養では結核菌は陰性であった。抗結核療法に対する奇異性反応と考え, 3日間の休薬後に, さらにプレドニゾロン投与を追加して初期治療を再開したが, 両側胸水貯留と低酸素血症は持続した。 |
| Author | 伊藤, 秀一 大畑, 雅洋 岡村, 城志 東本, 有司 上田, 晃子 藤本, 尚 西山, 明秀 駿田, 直俊 小野, 英也 川辺, 和美 伊藤, 康夫 石口, 正 |
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| References | 2) Onwubalili JK, Scott GM, Smith H: Acute respiratory dis-tress related to chemotherapy of advanced pulmonary tuber-culosis: A study of two cases and review of the literature. Quarterly Journal of Medicine. June 1986; New Series 59, No.230: 599-610. 10) Minamoto GY: Paradoxical presentation of intracranial tuberculomas after chemotherapy in a patient with AIDS. Clin Infect Dis. 1994; 19: 793-794. 12) Hejazi N, Hassler W: Multiple intracranial tuberculomas with atypical response to tuberculostatic chemotherapy. Infection. 1997; 25: 233-238. 8) Narita M, Ashkin D, Hollender ES, et al.: Paradoxical wors-ening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med. 1998; 158: 157-161. 9) Fishman JE, Lavi ES, Narita M, et al.: Transient chest radiographic worsening after initiation of antiretroviral therapy. AJR. 2000; 174: 43-49. 13) 新実彰男, 山本孝吉, 倉澤卓也, 他: 抗結核化学療法開始後の頭蓋内結核腫の悪化について. 日胸疾会誌. 1989; 27. 3) Bobrowitz ID: Reversible roentgenographic progression in the initial treatment of pulmonary tuberculosis. Am Rev Respir Dis. 1980; 121: 735-742. 6) Chensue SW, Warmington K, Ruth JH, et al.: Effect of slow release IL-12 and IL-10 on inflammation, local macrophage function and the regional lymphoid response during mycobacterial (Th 1) and schistosomal (Th2) antigen-elicited pulmonary granuloma formation. Inflamm Res. 1997; 46: 86-92. 1) Al-Majed SA: Study of paradoxical response to chemo-therapy in tuberculous pleural effusion. Respiratory Medi-cine. 1996; 90: 211-214. 7) Hiraoka K, Nagata N, Kawajiri T, et al.: Paradoxical pleural response to antituberculous chemotherapy and isoniazid-induced lupus. Respiration. 1998; 65: 152-155. 11) Afghani B, Lieberman JM: Paradoxical enlargement or development of intracranial tuberculomas during therapy. Clin Infect Dis. 1994; 19: 1092-1099. 4) Vilaseca J, Lopez-Vivancos J, Arnau J, et al.: Contralateral pleural effusion during chemotherapy for tuberculous pleurisy. Tubercle. 1984; 65: 209-210. 5) Matthay RA, Neff TA, Iseman MD: Tuberculous pleural effusion developing during chemotherapy for pulmonary tuberculosis. Am Rev Respir Dis. 1974; 109: 469-472. |
| References_xml | – reference: 12) Hejazi N, Hassler W: Multiple intracranial tuberculomas with atypical response to tuberculostatic chemotherapy. Infection. 1997; 25: 233-238. – reference: 6) Chensue SW, Warmington K, Ruth JH, et al.: Effect of slow release IL-12 and IL-10 on inflammation, local macrophage function and the regional lymphoid response during mycobacterial (Th 1) and schistosomal (Th2) antigen-elicited pulmonary granuloma formation. Inflamm Res. 1997; 46: 86-92. – reference: 3) Bobrowitz ID: Reversible roentgenographic progression in the initial treatment of pulmonary tuberculosis. Am Rev Respir Dis. 1980; 121: 735-742. – reference: 8) Narita M, Ashkin D, Hollender ES, et al.: Paradoxical wors-ening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med. 1998; 158: 157-161. – reference: 9) Fishman JE, Lavi ES, Narita M, et al.: Transient chest radiographic worsening after initiation of antiretroviral therapy. AJR. 2000; 174: 43-49. – reference: 1) Al-Majed SA: Study of paradoxical response to chemo-therapy in tuberculous pleural effusion. Respiratory Medi-cine. 1996; 90: 211-214. – reference: 4) Vilaseca J, Lopez-Vivancos J, Arnau J, et al.: Contralateral pleural effusion during chemotherapy for tuberculous pleurisy. Tubercle. 1984; 65: 209-210. – reference: 11) Afghani B, Lieberman JM: Paradoxical enlargement or development of intracranial tuberculomas during therapy. Clin Infect Dis. 1994; 19: 1092-1099. – reference: 13) 新実彰男, 山本孝吉, 倉澤卓也, 他: 抗結核化学療法開始後の頭蓋内結核腫の悪化について. 日胸疾会誌. 1989; 27. – reference: 5) Matthay RA, Neff TA, Iseman MD: Tuberculous pleural effusion developing during chemotherapy for pulmonary tuberculosis. Am Rev Respir Dis. 1974; 109: 469-472. – reference: 7) Hiraoka K, Nagata N, Kawajiri T, et al.: Paradoxical pleural response to antituberculous chemotherapy and isoniazid-induced lupus. Respiration. 1998; 65: 152-155. – reference: 10) Minamoto GY: Paradoxical presentation of intracranial tuberculomas after chemotherapy in a patient with AIDS. Clin Infect Dis. 1994; 19: 793-794. – reference: 2) Onwubalili JK, Scott GM, Smith H: Acute respiratory dis-tress related to chemotherapy of advanced pulmonary tuber-culosis: A study of two cases and review of the literature. Quarterly Journal of Medicine. June 1986; New Series 59, No.230: 599-610. |
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| Snippet | 症例は74歳男性。微熱を伴う右胸水貯留にて発症。喀痰や胸水の培養では結核菌陰性であったが, 胸膜生検の培養にて結核菌を認めた。治療は, イソニアジド (INH) 300mg/日, リファンピシン (RFP) 600mg/日, ピラジナミド (PZA) 1200mg/日にて施行。一時的には発熱は軽快したが,... |
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| SubjectTerms | 奇異性反応 慢性呼吸不全 抗結核化学療法 結核性胸膜炎 胸水 |
| Title | 結核性胸膜炎の治療中に対側の胸水をきたし, 慢性呼吸不全となった1症例 |
| URI | https://www.jstage.jst.go.jp/article/kekkaku1923/77/7/77_7_527/_article/-char/ja |
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