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Abstract A 77-year-old woman presented to hospital in December 2016 with back pain. She was diagnosed with thoracic compression fracture of the Th6 and Th8 vertebral bodies. She received conservative treatment, and the pain had improved. However, in September 2017, the pain worsened again, and in October 2017, paralysis of both lower limbs appeared, at which point, she was admitted to hospital again. Computed tomography (CT) revealed a tumor-like shadow around the Th6_Th8 vertebral bodies. Subsequently, she was transferred to our hospital. On admission, she was presented to the Department of Respiratory Medicine for abnormal shadows on chest CT. Chest CT revealed bronchiectasis and small nodules in the right middle and lower lobes and left lingular segment. As the sputum was not out, the patient’s gastric juice culture was analyzed; it was positive for
Myco-bacterium intracellulare. Needle biopsy samples from the areas of tumor-like shadows around the Th6_Th8 vertebral bodies were taken, and these were also positive for M.
intracellulare. Based on these ﬁ ndings, we diagnosed the patient’s condition as vertebral osteomyelitis due to M.
intracellulare; subsequently, she received antimycobacterial therapy with rifampicin, ethambutol and clarithromycin, following which, she underwent radical debridement and
decompression surgery with anterior spinal fusion. Postop-eratively, we continued antimycobacterial therapy for 2 months, and no recurrence was detected. The rate of osteo-articular nontuberculous mycobacterial (NTM) infection has been reported to be 1_2％. Although vertebral osteomyelitis due to NTM is rare, clinicians should consider the combina-tion of nontuberculous mycobacteriosis and vertebral osteo-myelitis in cases such as the case presented herein. Key words: Nontuberculous mycobacteria, Mycobacterium
avium complex, Vertebral osteomyelitis, Paresis, Thoracic fracture
1Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; 2Department of Respiratory Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital
Correspondence to: Chie Yamamoto, Department of Pul-monary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto-shi, Kyoto 602_ 8566 Japan. (E-mail: email@example.com) −−−−−−−−Case Report−−−−−−−−
VERTEBRAL OSTEOMYELITIS DUE TO MYCOBACTERIUM AVIUM COMPLEX
AFTER THORACIC FRACTURE: A CASE REPORT
1Chie YAMAMOTO, 2Haruka KUNO, 2Wataru FURUTANI, 2Isao HASEGAWA, and 2Yutaka KUBOTA
HLH Associated with TB / M. Tanigawa et al. 359
基準暫定案. 血栓止血誌. 2014 ; 25 : 629 646.
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hemophagocytic lymphohistiocytosis with initial presenta-tion of fever of unknown origin in a general hospital. Medicine. 2017 ; 96 : 1 5.
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11） Imashuku S: Differential diagnosis of hemophagocytic syndrome: underlying disorders and selection of the most effective treatment. Int J Hematol. 1997 ; 66 : 135 151. 12） Wang H, Xiong L, Tang W, et al.: A systematic review of
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13） Allen CE, Yu X, Kozinetz CA, et al.: Highly elevated ferritin levels and the diagnosis of hemophagocytic lympho-histiocytosis. Pediatr Blood Cancer. 2008 ; 50 : 1227 1235. 14） Lin F, Ferlic-Stark LL, Allen CE, et al.: Rate of decline of
ferritin in patients with hemophagocytic lymphohistiocy-tosis as a prognostic variable for mortality. Pediatr Blood Cancer. 2011 ; 56 : 154 155.
15） Asaji M, Tobino K, Murakami K, et al.: Miliary tubercu-losis in a young woman with hemophagocytic syndrome: a case report and literature review. Intern Med. 2017 ; 56 : 1591 1596.
16） 熊倉俊一：9. HPSの病態・診断・治療 Clinical feature, diagnosis and treatment of hemophagocytic syndrome. 血栓 止血誌. 2008 ; 19 : 210 215. 17） 小柳津治樹, 吉村千恵, 若山俊明, 他：結核, マイコプ ラズマ感染を契機とした血球貪食症候群の 2 例. 日呼 吸会誌. 1998 ; 36 : 787 792. 18） 藤木 玲, 白石 香, 野田和人, 他：粟粒結核に起因し た血球貪食症候群の1例. 結核. 2003 ; 78 : 443 448.
Abstract A 61-year-old man had terrible cough. He lost consciousness and displayed hypoglycemic coma and shock. He regained consciousness after receiving glucose infusion. His sputum sample tested positive for tuberculosis (TB)-PCR. Based on these results, he was diagnosed with pulmo-nary TB. He was diagnosed with hemophagocytic lympho-histiocytosis (HLH) based on the symptoms of high fever, pancytopenia, hyperferritinemia, hypoﬁ brinogenemia and hemophagocytosis in bone marrow, and with disseminated intravascular coagulation based on the symptoms of in-creased coagulation and ﬁ brinolysis. He was successfully treated with antituberculous drugs, steroids and anticoagu-lants. This case emphasizes the importance of early
diagno-sis and treatment for the successful treatment of HLH asso-ciated pulmonary TB.
Key words: Pulmonary tuberculosis, Hemophagocytic lym-phohistiocytosis, Disseminated intravascular coagulation, Hy-perferritinemia, Steroid
Department of Respiratory Medicine, Ise Red Cross Hospital Correspondence to: Motoaki Tanigawa, Department of Res-piratory Medicine, Ise Red Cross Hospital, 1_471_2, Funae, Ise-shi, Mie 516_8512 Japan.
(E-mail: firstname.lastname@example.org) −−−−−−−−Case Report−−−−−−−−
A CASE OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS
CAUSED BY PULMONARY TUBERCULOSIS
Motoaki TANIGAWA, Yuhei ITO, Hidetoshi ITANI, Hajime SASANO, and Hirokazu TOYOSHIMA