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 (648k)
Article in Japanese

Case Report

Paradoxical response with massive pleural effusion in a pulmonary tuberculosis patient diagnosed by thoracoscopy

Chika Yajimaa  Hiroyuki Takoia  Hiroki Hayashia  Shinji Abeb  Masahiro Seikea  Akihiko Gemmaa 

aDepartment of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
bDepartment of Respiratory Medicine, Tokyo Medical University

ABSTRACT

A 72-year-old male was treated with anti-tuberculosis drugs for pulmonary tuberculosis (rⅢ2). A large volume of right pleural effusion appeared after 2 months. We performed thoracoscopy procedures under local anesthesia for a differential diagnosis. Multiple white nodules were found on the parietal pleura and the biopsy specimen showed epithelioid cell granuloma without caseous necrosis. We diagnosed paradoxical response and continued the anti-tuberculosis therapy. The pleural effusion improved 3 months after treatment. Acid-fast bacterial staining and polymerase chain reaction (PCR) for Mycobacterium tuberculosis were conducted, and bacteria were not detected in the pleural effusion. Furthermore, culture test of the pleural effusion and biopsy specimens of the pleura were negative for bacteria. Based on these findings, it is speculated that an increased immune response to the mycobacteria on the pleura induced granuloma formation and pleural effusion. This is the first case report of paradoxical response on pleural lesions pathologically diagnosed using thoracoscopy under local anesthesia during antimicrobial therapy for pulmonary tuberculosis.

KEYWORDS

Pulmonary tuberculosis  Paradoxical response  Thoracoscopy  Pleural effusion  Pleural biopsy 

Received 17 Aug 2018 / Accepted 14 Nov 2018

AJRS, 8(2): 97-101, 2019

Google Scholar