人工透析と結核症-1-人工透析療法患者に発症した粟粒結核症

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概要

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• Risk of developing miliary tuberculosis is increased in a variety of disorders in which host defence mechanisms are impaired. We are presenting four cases of miliary tuberculosis which developed during dialysis therapy for chronic renal failure.<BR>The patients' age ranged from 34 to 59 years. None of them received corticosteroids or immunosuppressive therapy during their hospital treatment. These four patients had been treated at different time and different hospitals except cases 2 and 3. A previous histry of tuberculosis was recorded only in case 2. The clinical symptoms of these cases were fever of unknown origin, and cough and sputum during the period of dialysis therapy. Fever was the most frequently observed sign, which raised to 37-39°C after the dialysis or in the evening. The intermittent fever persisted without response to various antibiotics including CER, CEZ, TC, PC, etc. Two of them complained headache and became comatose in the final stage. Miliary lesions were not visible on the chest radiograms, even just before the time of death. The infiltrative shadows in S6 and pleural effusion were found in some cases temporarily on the chest radiograms during the clinical course. The duration of fever ranged from one month to 3 years. In case 2, the smear examination of sputum for acid-fast bacilli was negative, but positive culture was obtained one month after the death of patient. In case 3, one colony of acid-fast bacilli was cultured from the pleural effusion which disappeared without any antituberculous treatment. The serum BUN and creatinine levels were well controlled by the dialysis therapy in these four cases. The diagnosis of miliary tuberculosis were finally obtained by postmortem examination in all cases.<BR>The tuberculine skin test was not performed in these patients. It is well established that chronic uremia may influence certain immunological reactions and depress tuberculin skin test. This experience suggests that patients under dialysis therapy have a greater risk of developing miliary tuberculosis, and if fever of unknown origin is observed or tuberculosis is suspected, the prompt institution of antituberculous therapy including prophylactic ones is requested.

• 一般社団法人 日本結核病学会の論文

著者

• 藤野 忠彦

  慶応義塾大学医学部五味内科

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