多発性神経炎を初発症状とし肝機能異常を認めた粟粒結核の1例

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A case of miliary tuberculosis showing impaired liver function and polyneuritis was reported. A4l-year-oldd male, heavy drinker, was admitted because of acute onset of paraparesis and fever. physical examination revealed an emaciated man with enlarged lymph nodes in the supraclavicular fossa and enlarged liver. Neurological examination showed paraparesis. The knee and ankle jerks were absent, but there was no sensory impairment. On admission, chest X-ray showed pleural effusion on the right side. Laboratory examination revealed accelerated erythrocyte sedimentation rate, positive CRP, increased gammaglobulin and impaired liver function tests consisting of increased serum value of bilirubin, glutamic oxaloastic transaminase and alkaline phosphatase and thymol turbidity test. Staining of sputum, pleural effusion and cerebrospinal fluid was negative for acid fast bacilli. Because of difficulty in establishing diagnosis, biopsy of the enlarged lymph node was performed, which was diagnosed as tuberculous granuloma. It was after the establishment of the diagnosis, when culture of sputum, pleural effusion and cerebrospinal fluid turned out to be positive for acid fast bacilli. At this time, miliary shadows appeared on the chest X-ray which were not obvious on admission. Intensive therapy with antituberculous drugs was started, which resulted in gradual improvement of miliary tuberculosis, abnormalities of liver function and neurological symptoms. This case provides us an information that an impairment of liver function could be a prevailing clinical signs of miliary tuberculosis, and that miliary tuberculosis still exists nowadays and its clinical manifestations are manifold.
一般社団法人日本結核病学会の論文

多発性神経炎を初発症状とし肝機能異常を認めた粟粒結核の1例

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