title: [A case of pulmonary tuberculosis with diminished lung function whose paradoxical reaction led to death].
abstract: Paradoxical reaction in tuberculosis treatment is not generally fatal. On rare occasion it can lead a patient with diminished lung function and poor general condition to death. A 60-year-old man with history of left upper lobe resection from tuberculosis was referred to our hospital due to the recurrence of tuberculosis. Sputum examination showed a positive smear with a Gaffky score of 10, and the chest X-ray and CT revealed pulmonary infiltrate with many cavities (bII2) on the whole left lung field. Anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) were administered, but his high fever persisted, and the infiltrate on the chest X-ray deteriorated. While the positive sputum smear persisted, the culture became negative after one month. The tuberculous bacilli were susceptible to all anti-tuberculosis drugs in vitro. Though we performed examinations and trial treatments for non-tuberculous conditions such as pneumonia and drug-induced pneumonia, the patient died after 6 months. A necropsy specimen taken from the worsening lesion (the right upper lobe) as shown on the chest X-ray revealed many epithelioid granulomas. The patient had malnutrition, diabetes, alcoholic hepatic disorder, and insanity. It is supposed that although antituberculosis drugs were effective, a large quantity of killed organisms was continuously excreted from many cavities in the left lung toward the right lung. Lesions in the right lung thus newly produced in this paradoxical reaction seemed to reduce the remaining lung function. In addition, poorly controlled diabetes caused deteriorated heart function. These multiple factors contributed to the poor prognosis of the patient and his ultimate death.
authors: Department of Respiratory Medicine, National Hospital Organization Omuta National Hospital. oomura-h@oomuta-h.com
authors: Harutaka
authors: H
authors: Omura
authors: Akira
authors: A
authors: Kajiki
authors: Nobuhiko
authors: N
authors: Nagata
authors: Yoshinari
authors: Y
authors: Kitahara
authors: Kentarou
authors: K
authors: Wakamatsu
authors: Takahiro
authors: T
authors: Minami
authors: Kazuhito
authors: K
authors: Taguchi
authors: Katsuyuki
authors: K
authors: Katahira
mesh_terms: D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*