ソウキ ノ ゼンシン ステロイド リョウホウ ニヨリ キドウ ノ ハンコン キョウサク オ カイヒ デキタ キカンシ ケッカク ノ 1ショウレイ

35歳男性.入院約6週前より喀痰,咳嗽出現.数日前に左上肺空洞影指摘,喀痰中抗酸菌(3+)検出され入院.INH,RFP,PZA 及びEB による標準化学療法が開始された.咳嗽,呼吸困難,両肺野狭窄音聴取及び多量排菌持続し,気管支鏡所見上気管〜両側主気管支に隆起性潰瘍病変を認め,気管支結核を確定.高度の呼吸器症状遷延のため中等量のステロイド点滴投与を開始し,症状ならびに気道粘膜病変は改善した.高率に気管・気管支瘢痕収縮へ移行しうる気道粘膜像であったが,中等量の全身ステロイド療法により回避された.気道瘢痕狭窄回避のため,気管支結核活動性病変には中等量以上の全身ステロイド療法を考慮すべきと考えられた.A 35-year-old man admitted to the hospital because of acavitary lesion in the lung and acid-fast bacilli (AFB) (3+) in a sputum specimen, a polymerase-chain-reaction ofwhich revealed positive for M. tuberculosis. He had beenwell until approximately 6 weeks before admission, whenproductive cough developed. He also had temperature of upto 38 ℃, hoarseness, and shortness of breath couple of daysbefore. Intractable cough, dyspnea, wheeze in both lungfields, and numerous AFB in a sputum sustained, despiteprompt introduction of conventional chemotherapy containingINH, rifampicin, pyrazinamide, and ethambutol. Diagnosisof EBTB was confirmed by fibroptic bronchoscopy,which revealed granulomatous ulceration in the mucosa oftrachea and both main bronchi. Accordingly, intravenousmedium-dose methylprednisolone was administered, resultingrelief from serious respiratory manifestation and avoidanceof cicatricial stenosis of trachea and bronchi. This outcomesuggested that the current early intervention withglucocorticoid should be considered in serious active lesionof tracheal and bronchial mucosa in patients with EBTB

キョウクウ センパ ニヨル ノウキョウ ガッペイ オ ミトメタ セイジュクガタ ジュウカク キケイシュ ノ 1レイ

症例は16 歳女性,咳嗽,発熱,左前胸部痛を主訴に来院.胸部CT にて内部不均一な径7 cm の前縦隔腫瘍及び左舌区・下葉の完全無気肺を確認,また,MRI にて前縦隔腫瘍内に脂肪組織と同一の吸収域を認め,成熟型奇形腫穿破による膿胸と診断.膿胸に対し胸腔内繊維素溶解療法,ドレナージ及び抗生剤にて加療,膿胸改善を確認した上で,前縦隔腫瘍摘出術施行,病理にて嚢胞性成熟型奇形腫と診断した.病理組織にて膵類似の腺組織を確認,穿破の原因として,腫瘍内膵酵素の存在が考えられた.成熟型縦隔奇形腫は穿破により重篤な合併症発生の危険性があり,また経過中悪性転化する可能性もあることから,早期の外科治療が重要と考えられた.A 16-year-old female visited our hospital, complaining ofcough, fever, and left precordial pain. Chest computed tomographyshowed a heterogeneous anterior mediastinal tumormeasuring 7 cm in diameter and complete atelectasis inthe lingula and lower lobe of the left lung. Magnetic resonanceimaging also showed an area of intensity identical tothat of adipose tissue in the anterior mediastinal tumor.Thus, empyema due to rupture of a mature teratoma wasdiagnosed. The empyema was treated with intra-pleural fibrinolytictherapy, drainage, and antibiotics. After confirmingresolution of the empyema, we resected the anteriormediastinal tumor and pathologically diagnosed it as cysticmature teratoma. Histopathological examination showedglandular tissue resembling the pancreas, suggesting thatthe rupture had been caused by pancreatic enzymes in thetumor. Mediastinal mature teratoma carries a risk of seriouscomplications developing due to rupture and the possibilityof malignant transformation during the diseasecourse. Thus, early surgical treatment is important