[A case of pulmonary tuberculosis with multiple pneumatoceles in adult].

We describe a 32-year-old woman suspected of having pulmonary tuberculosis due to abnormal shadows found on her chest x-ray in a community health examination in September 2002. However, she consistently refused further examinations and treatment. In January 2005, she complained of a cough and sputum, by October she developed diarrhea, and by December a sore throat and fever. She was admitted to our hospital on January 23, 2006. Her chest radiograph revealed multiple thin-walled cystic lesions and infiltrative shadows in both upper lobes of the lung, a giant thin-walled cystic lesion in the superior segment of the left lower lobe, and diffuse particulate shadows. Since acid-fast staining of her sputum smear and a PCR test to detect tubercle bacilli both were positive, a diagnosis of pulmonary tuberculosis was made and we treated her with antituberculotic agents. Ten days after starting the treatment, her cystic lesions decreased or disappeared. Although she was seemingly healthy, her pulmonary tuberculosis became more severe since she failed to follow her treatment regimen. She therefore developed nutritional disorders and cellular immunity dysfunction that induced a sequence of changes, e.g. poor granuloma formation, excaration of caseous necrofic material by draining bronchi, and a check-valve mechanism. We speculate that these symptoms caused the formation of pneumatoceles. To our knowledge, this is the first case of pneumatocele formation found in a patient with pulmonary tuberculosis reported in Japan.

[A case of rapidly progressing pulmonary aspergillosis presenting various forms of shadow].

A 66-year-old woman who had a history of bullous pemphigoid was admitted to our hospital with abnormal shadows on chest radiography. She was being treated with prednisolone, which suggested that she might be in an immunosuppressed state. The chest radiograph and CT scan disclosed an infiltrative opacity, rapidly progressive cavitation, subsequent mycetoma formation, and a nodular shadow with a clear margin. Histological examination revealed a fungus ball in the cavitary lesion and a small mass of hyphae in necrotic tissue. After transbronchoscopic infusion of fluconazole, the cavitary lesion showed a marked resolution on the chest CT scan, and the infiltrative shadow and the nodule disappeared. It is said that aspergillosis is a spectrum of conditions whose precise manifestation is determined by the state of the lung tissue and by the patient's immune status. We report this rare case of pulmonary aspergillosis presenting various forms of shadow.