A 26year-old male who had been diagnosed as pulmonary tuberculosis three years agowith an antituberculous chemotherapy of only two months, complained of tiredness, exertional dyspnea and fever since a month ago. Bloody sputum, bloody stool andhematuria have developed three days before admission. Petechiae over the body trunk andlower extremities were observed on admission. Peripheral blood examination revealedlymphocytopenia (672/, μl), low hemoglobin content (6.2 g/dl), thrombocytopenia (3, 000/μ1), elevated FDP (36.2, μg/ml) and D-dimer (25.0 μg/ml) values. Chest radiograph showeda massive pleural effusion in the right hemithorax, bilateral pulmonary infitrates and acavity on CT scan. Together with positive acid-fast bacilli in sputum, diagnoses of relapsedpulmonary tuberculosis, tuberculous pleurisy associated with DIC (disseminated infravascular coagulation) were made. Left hydronephrosis which was presumed to be a consequence of infundibulum stenosis due to renal tuberculosis, was detected by abdominalultrasonography.
Treatment with antituberculous drugs and protease inhibitors were started withthoracic tube drainage. DIC condition was improved by the 20 th hospital day and sputumculture turned to be negative after the 4 th week, however, fever up to 38°C continued untilthe end of the 7 th week and a D-dimer which is a representative marker for secondaryfibrinolysis, continuously showed a high level up to the 10 th week of hospitalization. Thepatient was uneventful during the three months follow up period after discharge.
