HISTOLOGICAL OBSERVATION ON THE TUBERCULOUS LESIONS AGGRAVATED DURING RIFAMPICIN TREATMENT
1979 Volume 54 Issue 9 Pages 473-478
Details
1979 Volume 54 Issue 9 Pages 473-478
It has been noticed that the worsening of the X-ray shadows of tuberculous lung lesions, appearance of pleural effusion or enlargement of lymphnode tuberculosis were observed during the first to third month of anti-tuberculosis chemotherapy. The frequency was estimated to be 1 to 4% under SM treatment, whereas 8 to 14% during RFP administration. The reason why the most effective drug, RFP, provoke such worsening of the X-ray shadow more frequently, remains to be elucidated.
In this paper, a histological study on such a case was reported. A 32 years old female was treated by INH and RFP daily since the discovery of the infiltrative shadow in the left lung, though no tubercle bacilli was detected in sputum. X-ray film taken 3 months later, revealed appearance of new shadows around the original shadow, and the left upper lobe lobectomy was carried out considering the possibility of lung cancer. Histological examination of the resected lung showed a small, fibrotic walled cavity which contain few caseous necrosis in the narrow lumen, where a few acid-fast rods were found. Around this preceeding lesion, there was a newly formed caseous pneumonia of sublobular size, and aspirated caseous mass in the healthy alveolar spaces, showing that the aspiration pneumonia was probably the main feature of aggravation.
The other remarkable finding was the interstitial spread of the tuberculous change along the alveolar walls, interlobular septum or bronchial walls, where many epithelioid cell granulomas and/or lymphocytic infiltration were seen in conglomerulated or beaded form. Peribronchial inflammation and fibrosis resulted in bronchioloectasis and accumulation of necrotic mass in the lumens. The interstitial extension of the lesion could be based upon the some immunological changes during RFP treatment, as tuberculin reaction and lymphocyte blast transformation by PHA were known to reduce during the 1st to 2nd month of RFP treatment.
