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結核 第 94 巻 第 7 号 2019 年 7 月 412

Abstract [Objectives] According to the guideline published

from the Japanese Society for Tuberculosis, anatomical resec-tion more than segmentectomy is recommended for non-tuberculous mycobacteriosis (NTM). Although the indication is limited, surgical resection has effi cacy for NTM. The purpose of this study is to evaluate the effi cacy in disease free survival (DFS) and postoperative complication of surgical resection.

 [Methods] A total of 18 consecutive patients underwent resection of NTM in our institution between January 2012 and December 2017. Median follow-up term was 39.1 months. The recurrence was defi ned as postoperative positive sputum cultures or exacerbating lesions on radiological fi ndings.  [Results] Median age at operation was 66. Subjects were 4 (22%) males and 14 (78%) females. Six patients (33%) had a history of smoking. Twelve (67%) had Mycobacte-rium avium, 3 (16%) had M.intracellulare, 2 (11%) had M.xenopi, 1 (6%) had M.abscessus. The surgical procedure included wedge resection (N=1; 6%), segmentectomy (N=2; 11%), lobectomy (N=11; 61%), lobectomy with combined

resection (N=4; 22%). Postoperative complications occurred in 2 patients and there was no mortality. In the follow-up periods, 4 patients developed recurrence and 3-year DFS was 85%.

 [Conclusion] There were no severe postoperative compli-cation and mortality. Surgical resection could be an effective treatment for pulmonary NTM.

Key words: Non-tuberculous mycobacteriosis, Surgical

treat-ment, Postoperative complication, Disease free survival, Recurrence

¹Department of Thoracic Surgery, ²Department of Respiratory Medicine, National Center for Global Health and Medicine Correspondence to: Keigo Sekihara, Department of Thoracic Surgery, National Center for Global Health and Medicine, 1_21_1, Toyama, Shinjuku-ku, Tokyo 162_8655 Japan. (E-mail: ksekihara@hosp.ncgm.go.jp)

−−−−−−−−Original Article−−−−−−−−

RESULTS OF SURGICAL RESECTION FOR NON-TUBERCULOUS MYCOBACTERIOSIS

¹Keigo SEKIHARA, ¹Yuki ISHIGURO, ¹Hoshie HIRAI, ²Yusaku KUSABA,

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Pneumothorax & NTM Infections / J. Miyakoshi et al. 417

Differentiation of Mycobacterium massiliense from Myco-bacterium abscessus. Am J Respir Crit Care Med. 2011 ; 183 : 405 410.

10) Nash KA, Brown-Elliott BA, Wallace RJ Jr., et al.: A novel gene, erm (41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Che-mother. 2009 ; 53 : 1367 1376.

11) Shin SH, Jhun BW, Kim SY, et al.: Nontuberculous Mycobacterial Lung Diseases Caused by Mixed Infection with Mycobacterium avium complex and Mycobacterium abscessus complex. Antimicrob Agents Chemother. 2018 ; 10 : 1105 1118. 12) 福元重太郎, 猪島一郎, 藤田昌樹, 他:気胸・胸膜炎を 合併した肺 Mycobacterium intracellulare 症の1例. 結核. 2005 ; 80 : 571 575. 13) 西川敏雄, 高橋正彦, 森 雅信, 他:Mycobacterium ab-scessus肺感染症による続発性気胸の 1 手術症例. 日呼 吸会誌. 2015 ; 29 : 84 88. 14) 水谷尚雄, 萱野公一:肺末梢孤立性の Mycobacterium avium intracellulare complex 感染巣による続発性自然気 胸の一例. 日呼外会誌. 2008 ; 22 : 943 947.

15) 安藤克敏, 石井正紀, 米永暁彦, 他:非結核性抗酸菌症 治療中に気胸を発症した高齢女性の 1 例. 日老医誌. 2018 ; 55 : 136 142.

Abstract: A 61-year-old woman with rheumatoid arthritis and

connective tissue disease-related interstitial pneumonia visited our department for cavitation in upper lobe of right lung. She had been treated with oral methylprednisolone and 2 cycle of cyclophosphamide pulse therapy. Sputum acid-fast bacte-rium (AFB) culture was positive, of which mycobactebacte-rium was two species of nontuberculous mycobacterium (NTM), M. avium and M.abscessus complex. Each NTM was shown two times respectively and M.abscessus complex was identi-fi ed as M.abscessus subsp. massiliense. So she was diagnosed as mixed infection of M.avium and M.abscessus subsp. mas-siliense. She was treated with clarithromycin, ethambutol, amikacin, imipenem and cilastatin fi rst 2 months, followed by clarithromycin, ethambutol and faropenem. Sputum AFB culture became negative after 4 months from treatment started, and thereafter it was kept to be negative. But soon after she developed secondary pneumothorax. Air leak was shown from the cavity. This pneumothorax was not able to be treated

with conservative therapy and needed surgical treatment. Our experience of the present case suggest the treatment strategy of NTM mixed infections and the mechanism that NTM infection cause secondary pneumothorax.

Key words: Connective tissue disease-related interstitial

pneumonia, Nontuberculous mycobacteria, M.avium, M.ab-scessus subsp. massiliense, Secondary pneumothorax

1Department of Respiratory Medicine, Tokyo Metropolitan

Tama Medical Center Hospital; 2Department of Respiratory

Medicine, Tokyo Rosai Hospital

Correspondence to: Kengo Murata, Department of Respi-ratory Medicine, Tokyo Metropolitan Tama Medical Center Hospital, 2_8_29, Musashidai, Fuchu-shi, Tokyo 183_8524 Japan. (E-mail: kengo_murata@tmhp.jp)

−−−−−−−−Case Report−−−−−−−−

A CASE OF SECONDARY PNEUMOTHORAX AFTER A TREATMENT OF

MIXED INFECTION OF MYCOBACTERIUM AVIUM

AND MYCOBACTEROIDES ABSCESSUS SUBSP. MASSILIENSE

1, 2Jun MIYAKOSHI, 1Kengo MURATA, 1Masatoshi TACHIBANA, 1Takahiro FUKUSHIMA, 1Koichi YANO, 1Miake YAMAMOTO, 1Yu SATOH, 1Akihiko WADA,

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Tuberculosis and Aplastic Anemia / N. Matsuo et al. 423

Abstract: Immunosuppression has bad effects not only on

the incidence of tuberculosis but also on the treatment. In this paper, we reported a case that a patient developed aplastic anemia during the treatment of tuberculosis.  The patient, an 85-year-old man, was admitted to our hospital because of pulmonary tuberculosis. We started to treat him with three anti-tubercular agents: isoniazid (INH), rifampicin (RFP), ethambutol (EB). After two months of combination therapy INH/RFP/EB, EB was stopped accord-ing to a guideline that was published by the Japanese Society for Tuberculosis. Five months after the anti-tubercular agents were introduced, laboratory tests revealed severe pancytopenia. He had undergone bone marrow aspiration, which confi rmed the diagnosis of aplastic anemia. This was thought to be a side effect of anti-tuberculosis agents. Therefore, we decided to change anti-tuberculosis agents from INH and RFP to streptomycin (SM) and levofl oxacin (LVFX). As for aplastic anemia, we selected metenolone acetate and eltrombopag, because we needed to avoid immu-nosuppressive therapy due to pulmonary tuberculosis. After 13 months, he completed the treatment of tuberculosis.

Regarding aplastic anemia, laboratory tests did not show pancytopenia.

 Some cases were reported that severe pancytopenia developed during the treatment of tuberculosis. It is neces-sary to pay attention to both side effects and accidental blood diseases. Additionally, when patients have pancyto-penia during the tuberculosis treatment, we need to select a treatment that is both effective against tuberculosis and blood diseases.

Key words: Tuberculosis, Aplastic anemia,

Immunosuppres-sion, Eltrombopag, Pancytopenia

1Department of Respiratory Medicine, 2Department of Blood

Medicine, Nagasaki Harbor Medical Center; 3Second

Depart-ment of Internal Medicine, Nagasaki University Hospital

Correspondence to: Nobuko Matsuo, Department of

Respi-ratory Medicine, Nagasaki Harbor Medical Center, 6_39, Shinchi-machi, Nagasaki-shi, Nagasaki 850_8555 Japan. (E-mail: nobumaru1024@gmail.com)

−−−−−−−−Case Report−−−−−−−−

A CASE OF PULMONARY TUBERCULOSIS WITH SEVERE PANCYTOPENIA

DURING THE TREATENT, LEADING TO DIAGNOSIS AS

APLASTIC ANEMIA AND LEADING IMPROVEMENT TREATMENT

WITH METENOLONE ACETATE AND ELTROMBOPAG

1Nobuko MATSUO, 2Hideki TSUSHIMA, 1Toyomitsu SAWAI, 1Kazumasa AKAGI, 1Shotaro IDE, 1Sumako YOSHIOKA, and 3Hiroshi MUKAE

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