[15 cases of pulmonary Mycobacterium scrofulaceum infection].

OBJECTIVES: We described clinical features of pulmonary Mycobacterium scofulaceum disease. MATERIALS AND METHODS: We described 15 cases of pulmonary Mycobacterium scrofulaceum infection admitted to National Hospital Organization Omuta National Hospital from 1989 to 2003 and reviewed the clinical feature, the findings of chest radiograph, and clinical course. RESULTS: Sex ratio was 8 male cases and 7 female cases, and the average age was 65.9 years old. Smoking history was found in 8 patients and occupational history of the dust inhalation was found in 7 patients with pulmonary M. scrofulaceum infection. There were 11 cases of tuberculosis-like form and 4 cases of nodular-bronchiectasis form according to the NTM Research society classification based on the findings of chest radiography. Improvement of the findings of chest radiography was seen in 4 patients by therapy, while no change or aggravation in 11 patients. Five patients died and among them, 3 died due to aggravation of pulmonary M. scrofulaceum infection. DISCUSSION: Cases showing tuberculosis-like form were dominant, and most of them showed extensive lesions when they were diagnosed, and these facts were considered to be major factors of difficulty in the treatment of this infection. The facts that 7 cases had occupational exposure to the dust, obstructive pulmonary disease in 3 cases, and 6 cases showed sputum culture positive for other nontuberculous mycobacteriosis, suggest that local resistance of lung might be attenuated, and this could be one of factors of onset and development of this infection. Only 4 cases showed improvement, while 5 cases died (primary disease death in 3 cases) and it was thought that the prognosis of the disease was in general poor.

[A case of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall].

A 61-year-old woman with schizophrenia that had been treated in a psychiatric hospital was admitted to our hospital because of subileus and back pain. Though subileus was improved, she had a sudden attack of fever 7 days later and developed right pleural effusion, a cold abscess in the anterior chest wall and swelling of a thumb-sized right cervical lymph node which broke through the skin. We made a diagnosis of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall due to the biopsy findings of the specimen taken from the cervical lymph node, examination of pleural effusion, chest CT, bacteriological examination of the cold abscess and spinal MRI. We started chemotherapy with the antituberculous drugs (HRSZ) and symptoms except back pain improved. She complained of paresis of the both lower extremities, which completely paralyzed 8 months later in spite of continued chemotherapy. Thereafter her paralysis was gradually improved and she was able to walk by herself after 12 months chemotherapy.

[A case of interstitial pneumonia induced by an ACE inhibitor (temocapril hydrochloride)].

A 51-year-old woman who had been treated for years for rheumatoid arthritis presented with a persistent dry cough and shortness of breath three weeks after administration of the ACE inhibitor temocapril hydrochloride against essential hypertension. Chest radiography and computed tomography showed diffuse reticular shadows and ground-grass opacities in both lung fields. Bronchoalveolar lavage fluid analysis showed an increase of lymphocytes and CD8+ T cells (93.3% of lymphocytes), and a decrease of the CD4/8 ratio of the T cell subset (0.04). Histopathological analysis of trans-bronchial lung biopsy specimens showed infiltration of lymphocytes into the alveolar septa and exudation of alveolar macrophages, signs characteristic of interstitial pneumonia. A drug lymphocyte stimulation test was positive for temocapril, but negative for other drugs. On the basis of these findings, we diagnosed temocapril hydrochloride-induced interstitial pneumonia.