2020 Volume 42 Issue 2 Pages 157-163
Background. The bronchopneumonia pattern of pulmonary tuberculosis is relatively uncommon, and its rapid progression is extremely rare. Case. A 68-year-old Japanese man with pneumoconiosis and diabetes mellitus started to experience coughing in November the year before his admission, and treatment with inhaled corticosteroid (ICS) was started for bronchial asthma at a primary care clinic. However, his symptom of coughing worsened from the following April, and chest computed tomography (CT) showed multiple small nodules. He was therefore referred to our hospital. At the first visit to our hospital, he refused further examinations, but after he developed a productive cough with a high-grade fever on the end of June, he eventually was admitted to our hospital two days later. On admission, elevated peripheral blood leukocyte counts and C-reactive protein levels were observed, and chest CT showed consolidations accompanied by air bronchograms, mainly in the right upper and left lower lobes. Treatment with antimicrobial agent was ineffective, so a bronchoscopic examination was performed on hospital day 4, revealing positive acid-fast bacilli. Polymerase chain reaction was performed for the detection of Mycobacterium tuberculosis and culture for M. tuberculosis, and he was finally diagnosed with bronchial and pulmonary tuberculosis. Conclusions. The comorbid diseases of pneumoconiosis and diabetes mellitus in the present patient may have been related to his cell-mediated immune deficiency, and the use of ICS may have contributed to the rapid progression of bronchopulmonary tuberculosis in a short period of time.
