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日本呼吸器学会英文誌 Respiratory Investigation
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Abstract

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Article in Japanese

Diagnostic Imaging

A case of disseminated tuberculosis without miliary nodules in the lung

Hirokazu Iso  Toru Tanaka  Takeru Kashiwada  Yoshinobu Saito  Masahiro Seike  Akihiko Gemma 

Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School

ABSTRACT

We report the case of a 23-year-old Japanese female patient with Sjögren's syndrome who had been treated with methotrexate and azathioprine for 10 years. She experienced fatigue, fever, and lower back pain, which had persisted for 2 months, and presented with hilar and mediastinal lymphadenopathy on contrast-enhanced chest computed tomography (CT). Further examination revealed no active lesions in the lung fields; however, multiple lesions were detected in the lymph nodes, bone, subcutaneous tissue, peritoneum, and colon. Sputum specimens could not prove the presence of Mycobacterium tuberculosis, and a T-SPOT®.TB test was negative. We performed endobronchial ultrasound-guided transbronchial needle aspiration and obtained a specimen from the mediastinal lymph nodes. Although an acid-fast bacilli smear and polymerase chain reaction for M. tuberculosis were negative, the specimen showed granulomatous lesions and M. tuberculosis was subsequently cultured. We finally diagnosed disseminated tuberculosis.
Clinicians should be alert to the possibility of disseminated tuberculosis even in the absence of miliary nodules in the lung and negative interferon gamma release assay (IGRA) results.

KEYWORDS

Tuberculosis  Disseminated tuberculosis  Interferon gamma release assay (IGRA) 

Received 1 Feb 2022 / Accepted 30 Mar 2022

AJRS, 11(4): 228-231, 2022

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