一般社団法人日本呼吸器学会 公式サイト
日本呼吸器学会英文誌 Respiratory Investigation
日本呼吸器学会誌 増刊号 学術講演会プログラム 抄録集

Abstract

Full Text of PDF Full Text of PDF (735k)
Article in Japanese

Case Report

A case of organizing pneumonia as a result of a transbronchial spread of dead Mycobacterium tuberculosis complex in bronchial tuberculosis

Hiroyuki Takoi  Yoshiya Tsunoda  Shin-Yuan Lin  Akimasa Sekine  Kenji Hayashihara  Takefumi Saito 

Department of Respiratory Medicine, National Hospital Organization, Ibaraki-Higashi National Hospital

ABSTRACT

An 80-year-old male was treated with standard antituberculosis agents for lung tuberculosis of the right upper lobe. After discontinuation of this treatment, his chest radiograph showed new infiltration in the right lower lobe of lung. Bronchial lavage of the right basal bronchus revealed polymerase chain reaction positivity, but culture negativity for Mycobacterium tuberculosis complex and a biopsy specimen showed intra-alveolar organization and fibrosis. Furthermore, bronchoscopic findings of the right B1 were compatible with bronchial tuberculosis. These results suggest that dead bacteria in the right B1 were transbronchially spread to the ipsilateral lower lobe, raising an allergic reaction and forming an organized lesion. Locally hypersensitive response to the dead bacteria may be the main pathogenesis of the “paradoxical response.” Moreover, it is important to consider bronchial tuberculosis when a new lesion in an area away from the original disease is observed in pulmonary tuberculosis showing no cavitary lesion.

KEYWORDS

Bronchial tuberculosis  Paradoxical response  Transbronchial spread  Intraalveolar organization  Bronchoscopy 

Received 24 Oct 2012 / Accepted 31 Jan 2013

AJRS, 2(4): 401-404, 2013

Google Scholar