Multiple tuberculous nodules with metachronous changes: a case report.
BACKGROUND
Spontaneous regression of lesions occurs in non-infectious benign diseases, such as sarcoidosis, as well as in infectious diseases, such as tuberculosis. Lung cancer and malignant lymphoma, on the other hand, rarely follow a similar course. We report a rare case of lung tuberculosis that presented with multiple nodules with metachronous changes in size.


METHODS
We describe the case of a 50-year-old immunocompetent Japanese man with pulmonary tuberculosis in the form of multifocal nodules. He came to our hospital because of a chest X-ray abnormality. During the course of observation, some nodules reduced while others enlarged in size. Two years after the first visit, fever and pleural effusion appeared. The sputum examination turned out to be positive for tuberculosis. A course of anti-tubercular agents resolved the pleural effusion and multifocal nodules.


CONCLUSIONS
Differences in the manner of granuloma formation suggest that the local immune response can be different even in the same lung field.
Department of Pulmonary Medicine, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Japan. munesumi@hotmail.com
Munehisa
M
Fukusumi
Tatsuya
T
Ibe
Shinjiro
S
Takeoka
Kazushige
K
Wakuda
Atsuto
A
Mouri
Yoichiro
Y
Hamamoto
Mitsuhiro
M
Kamimura
D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology