Abstract
A 72-year-old man was admitted because of pulmonary tuberculosis and hypertension. On admission X-ray films of the chest disclosed a cavity in the posterior segment of the left upper lobe. Acid-fast bacilli were found in the sputum (Gaffky 2), and the cultures yielded mycobacterium tuberculosis. The blood pressure was 182/102mmHg. He was treated with INH, streptomycin, rifampicin, ethambutol and trichloromethiazide.
Seven months after the beginning of the treatment, he suddenly complained of dyspnea and non-productive cough. Chest X-ray films showed diffuse intersitial infiltrates in both mid- and lower-lung areas. The partial pressure of oxygen of the arterial blood (PaO2) was 59.1 Torr, PaCO2 32.4 Torr and the pH7.376, while he was breathing room air. The tests for antinuclear antibody, RA and LE-cells were positive, but those on admission negative. Fiberoptic bronchoscopical examination was performed and cultures of the washing and brushing materials yielded no acid-fast bacilli. Transbronchial biopsy specimen obtained from the right middle lobe showed pulmonary fibrosis with mild infiltration of lymphocytes. Prednisolone 30mg/day was administered, and dry cough, dyspnea and the diffuse interstitial shadows in the lung diminished gradually. Lymphocyte stimulation index by INH was 198% and that by trichloromethiazide 85%, when tested 6 months later.
These findings suggest strongly that the pulmonary interstitial lesion is INH-induced interstitial pneumonia.
