[Clinical and radiological features of tuberculous pneumonia in patients with emphysema].
OBJECTIVE
To elucidate the clinical and radiological features of tuberculous pneumonia in patients with pulmonary emphysema.


METHODS
Three emphysematous cases diagnosed with tuberculous pneumonia are clinically and radiologically reviewed.


RESULTS
Case 1 was a 62-year-old male with an infiltrate in the right upper lobe. A CT scan showed diffuse emphysema and a nonsegmental infiltrate without typical signs of bronchogenic spread. Sputum was negative for acid-fast bacilli. The infiltrate showed a nonsegmental spread unresponsive to antibiotics. Mycobacterium tuberculosis grew from a needle biopsy specimen five weeks after admission. The infiltrate disappeared with antituberculous treatment. Case 2 was an 82-year-old male, who presented with seven weeks of low-grade fever followed by high fever and lobar pneumonia in the right upper lobe. Sputum was positive for acid-fast bacilli on smear and tuberculosis PCR, leading to a diagnosis of tuberculous pneumonia. Case 3 was a 57-year-old male who had a history of dry cough lasting for one month. CT findings included a diffuse emphysematous change and a left upper lobe infiltrate, indistinguishable from bacterial pneumonia. His bronchoalveolar lavage was positive for tuberculosis PCR, which led to a diagnosis of tuberculous pneumonia.


CONCLUSIONS
Tuberculous pneumonia in emphysematous patients can be nonsegmental, lacks bronchogenic spread, is indistinguishable from bacterial pneumonia, and clinically shows a poor inflammatory reaction, which is distinct from classical "caseous pneumonia.
Yoshikawa
Mitsuhiro
M
Department of Medicine, Kawakita General Hospital, 1-7-3, Asagayakita, Suginami-ku, Tokyo 166-8588, Japan. yosikam-tky@umin.ac.jp
Tokuda
Hitoshi
H
Kasai
Shogo
S
Kitagawa
Hiroshi
H
Oishi
Nobuya
N
Nagase
Takahide
T
D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology; D011656:Pulmonary Emphysema / Q000150:complications*; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology