Ofloxacin in miliary tuberculosis

We report one case of severe miliary tuberculosis with liver failure and respiratory insufficiency in a twenty-seven year old patient. We emphasize the presence of hepatic, occular and vestibular toxicities secondary to the treatment and the usefulness of ofloxacin with cycloserine given for nine months.     

Fibreoptic bronchoscopy in smear-negative pulmonary tuberculosis

Fifty smear-negative pulmonary tuberculosis patients underwent fibreoptic bronchoscopy. Bronchial aspirate smears of twelve patients and post-bronchoscopic sputum smears of fourteen patients were positive for acid-fast bacilli (AFB). Bronchial biopsy provided the diagnosis in 9 out of 30 patients. Brush smears were positive in 28 patients, being the only positive sample in ten cases. A high yield from brush smears was obtained due to their preparation from caseous material wherever visible in the bronchi. With these results a rapid diagnosis was established in 36 of the 50 patients. When culture results were available, a definite diagnosis of tuberculosis was made in 45 of the patients. The yield from brush smears was found to be significantly better when compared to bronchial aspirate smears (p less than 0.01) and post-bronchoscopic sputum smears (p less than 0.01).     

Bilateral spontaneous pneumothorax in miliary tuberculosis

Pneumothorax is a common complication in pulmonary tuberculosis that is usually seen with underlying cavitary lesion. However, it is uncommonly seen in patients with miliary tuberculosis. This communication describes bilateral spontaneous pneumothorax in an 18 years' old female patient having miliary tuberculosis.     

Miliary sarcoidosis following miliary tuberculosis

A patient who presented with a miliary radiographic pattern due to tuberculosis and later with a similar miliary pattern due to sarcoidosis is described. The patient, a 47-year-old man, was admitted to the hospital due to coughing, weakness, weight loss and an abnormal chest radiograph with a miliary pattern. A gastric fluid culture was positive for Mycobacterium tuberculosis and he was treated appropriately. He showed complete clinical and radiological remission. One year later he presented with a dry cough and a similar miliary pattern on the chest roentgenogram. Lung biopsy taken by thoracoscopy revealed sarcoidosis. The patient had a complete remission with corticosteroids. To our knowledge, this is the first report describing a miliary pattern as presenting radiological sign in a patient with tuberculosis who subsequently developed a new miliary pattern due to sarcoidosis.     

Thymoma complicated with miliary tuberculosis

We report a case of thymoma complicated with miliary tuberculosis. A 69-year-old woman was admitted to a hospital because of body weight loss, general fatigue, and dyspnea. Chest X-ray showed a small, diffuse granular shadows in both lungs. Biopsied-specimens from bone marrow and left pharynx revealed granuloma with both giant cells and caseous necrosis. The diagnosis of miliary tuberculosis was made. The patient was then transferred to our hospital. Both chest X-ray and computed tomography conducted on admission revealed a mass in the mediastinum as well as diffuse granular shadows in both lungs. We suspected a presence of thymoma. Anti-tuberculosis therapy was started, and extended thymectomy was performed. The diagnosis of thymoma was confirmed pathologically. Immunological analysis of peripheral blood lymphocytes was done before and after the operation. Negative conversion of PPD reaction was observed after thymectomy. Although the response of peripheral lymphocytes to phytohaemoagglutinin (PHA) and concanavalin A recovered after thymectomy, a marked decrease of the number of CD 4 T cells, a decrease of T helper 1 cells, a slight increase in the number of B cells and cells expressing natural killer cell-related surface markers were observed throughout the course of illness.     

菌阴肺结核在结核病控制中的重要性

菌阴肺结核是指经痰涂片抗酸杆菌（AFB）和痰培养分枝杆菌检查均为阴性的活动性肺结核类型，大约占全部肺结核的40％～60％，是结核病控制工作中不可忽视的群体。