An Autopsy Case of "Non-reactive" Miliary Tuberculosis Associated with Chronic Myeloid Leukemia
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A 68-year-old housewife, was admitted on November 15, 1977, complaining of tumor in the left hypochondrium. Her remarkably enlarged spleen was palpable and chronic myeloid leukemia was diagnosed on the basis of hematological examinations. Chemotherapy with busulfan was performed for about eight months. Consequently, leukemic cells in the blood as well as the splenomegaly disappeared almost completely. However on August 1, 1978, she had a sudden onset of high fever. At the same time, the chest roentgenogram showed a rapid enlargement of the pulmonary hilar shadow and peripheral blood findings showed prominent progressive agranulocytosis. Antibiotics were administered intensively, but the fever did not respond and she expired on August 22, 1978.Autopsy revealed tuberculous lymphadenitis of the pulmonary hilar lymph nodes and scattered miliary necrotic lesions in the liver, spleen, lung and bone marrow. Histologically, there was little or no cellular reaction around these necrotic lesions, though numerous tubercle bacilli were demonstrated in them. Therefore, these necrotic lesions were interpreted as so-called "non-reactive" miliary tubercle. In addition, leukemic cell infiltration was seen in various organs.It had been previously believed that the occurrence of tuberculosis in patients with leukemia is infrequent. However the complication of miliary tuberculosis is often clinically unsuspected and can be fatal. Though the survival period of leukemic patients has been prolonged with the recent advance of anti-leukemic treatment, the possibility of the complication of miliary tuberculosis in leukemic patients under such immunosuppressive conditions must be emphasized.
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社団法人 日本呼吸器学会 | 論文
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