特発性間質性肺炎の治療中に肺結核症を併発した高齢者の1例

Abstract

A case of idiopathic interstitial pneumonia with pulmonary tuberculosis is reported. The patient was a 70-year-old man. On March 14, 1997, he visited Saiseikai Gose Hospital because of dyspnea on effort, which started in early March. He was diagnosed with acute interstitial pneumonia and admitted to the hospital the same day. After admission, respiratory failure worsened, but after steroid pulse therapy, respiratory func- tion improved. Since April 20, the patient complained of cough and fever again, and tubercle bacilli, Gaffky Ⅶ, were found in his sputum. He was admitted to our hospital for treatment of pulmonary tuberculosis. The Gaffky score decreased with therapy, but liver dysfunction developed, so treatment was interrupted. Early in September, respiratory failure worsened again. Gaffky score was 0, but chest X-ray findings led to a diagnosis of recrudescence of idiopathic interstitial pneumonia. After steroid pulse therapy, the patient' s repiratory function improved again. Subsequently, we reduced the steroid dosage gradu- ally. He was dischanged on May 3, receiving predonisolone 10 mg/day. This case suggests that in elderly patients under steroid therapy Mycobacterium tubercu- losis infection should be considered even in the absence of a history of tuberculosis.