臨牀透析 Vol.32 No.2(6-4)


特集名 高齢・超高齢透析患者の致死的感染症
題名 特殊な感染症 (4) 粟粒結核
発刊年月 2016年 02月
著者 船越 哲 衆和会長崎腎病院
著者 原田 孝司 衆和会長崎腎病院
【 要旨 】 透析患者の結核症は一般人よりはるかに多く,その特徴としては肺外結核や粟粒結核が多い.今回われわれは,水疱性類天疱瘡治療のためプレドニゾロン8 mgを内服中の81歳,女性に発症した粟粒結核を経験した.発熱とCRP 高値,また胸部CTで両肺に微細な粒状影が多数認められ,搬送先の呼吸器専門機関にて喀痰・胃液のPCRで結核感染が確定診断された.INH 150 mg/day,RFP 300 mg/day,EB 500 mg/透析後で開始し,患者の全身状態は改善した.透析患者の場合,陳旧性結核が転移源となって肺内播種する粟粒結核(内因性再燃)が多いため,「まず疑ってかかること」が早期発見・治療のうえで重要と思われた.
Theme Fatal infections of elderly and super-elderly dialysis patients
Title Miliary tuberculosis
Author Satoshi Funakoshi Nagasaki Kidney Hospital
Author Takashi Harada Nagasaki Kidney Hospital
[ Summary ] The incidence rate of tuberculosis (TB) in dialysis patients is much higher than in the general population, and is characterized by a high prevalence of extrapulmonary and miliary TB. An 81-year-old female dialysis patient who received prednisolone for bullous pemphigoid developed a fever and exhibited elevated C-reactive protein levels. Chest computed tomography revealed randomly distributed miliary nodules in both the lungs. She was referred to a pulmonary specialist, and a diagnosis of TB was established based on sputum and gastric fluid analysis. Treatment with isoniazid 150 mg/day, rifampicin 300 mg/day, and ethambutol 500 mg after every dialysis session was started, and the patient recovered. It is important to have a high index of suspicion for TB in elderly dialysis patients to ensure early diagnosis and treatment because miliary TB may develop from reactivation of old tuberculosis lesions in patients who are immunocompromised or are on dialysis.
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