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: email@example.com)
RESULTS OF SURGICAL RESECTION FOR NON-TUBERCULOUS MYCOBACTERIOSIS¹Keigo SEKIHARA, ¹Yuki ISHIGURO, ¹Hoshie HIRAI, ²Yusaku KUSABA,
Pneumothorax & NTM Infections / J. Miyakoshi et al. 417
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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: firstname.lastname@example.org)
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,
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: email@example.com)
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