[A case of tuberculous pleurisy with transient new intra-pulmonary lesions during anti-tuberculosis therapy].
A 24-year-old man who had been treated 3 months for tuberculous pleurisy presented with thoracic back pain. Chest CT showed a new lesion abutting the pleura, despite the disappearance of pleural effusion. Two weeks later, the mass abutting the pleura progressed to form a new intrapulmonary infiltrative shadow. A transbronchial lung biopsy was performed and the histopathologic examination of the specimen from this lesion revealed granulomatous inflammation without caseous necrosis or acid-fast bacilli. No acid-fast bacilli were cultured from the bronchoalveolar lavage fluid. Anti-tuberculosis medication was continued without change, and the lesions finally resolved. More than 3 years have passed since the completion of anti-tuberculosis chemotherapy, and no recurrence has been observed. We believe that these lesions were pulmonary tuberculomas and transient intra-pulmonary infiltration due to non-specific inflammation, caused secondarily by an excessive immune response, as in paradoxical worsening.
Nishio
Kazumi
K
Department of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, 2-27-1, Ida, Nakahara-ku, Kawasaki-shi, Kanagawa 211-0035, Japan. nishio-k@city.kawasaki.jp
Aida
Shinji
S
Nakano
Yasushi
Y
Okabayashi
Ken
K
Shimada
Hisato
H
D000995:Antitubercular Agents / Q000627:therapeutic use*; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008168:Lung / Q000473:pathology*; D008297:Male; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D014396:Tuberculosis, Pleural / Q000188:drug therapy* / Q000473:pathology*; D055815:Young Adult
D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin