Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Miliary Tuberculosis Misdiagnosed as Pneumonia and ARDS Due to the Transient Improvement after Intravenous Injection of Levofloxacin

폐렴, 급성호흡곤란증후군으로 오인되어 Levofloxacin 투여 후 호전되어 진단이 지연된 속립성 결핵 1예

  • Lee, Go Eun (Division of Pulmonology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Cho, Young Jun (Department of Diagnostic Radiology, Konyang University College of Medicine) ;
  • Cho, Hyun Min (Department of Diagnostic Chest Surgery, Konyang University College of Medicine) ;
  • Son, Ji Woong (Division of Pulmonology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Choi, Eu Gene (Division of Pulmonology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Na, Moon Jun (Division of Pulmonology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kwon, Sun Jung (Division of Pulmonology, Department of Internal Medicine, Konyang University College of Medicine)
  • 이고은 (건양대학교 의과대학 내과학교실) ;
  • 조영준 (건양대학교 의과대학 영상의학교실) ;
  • 조현민 (건양대학교 의과대학 흉부외과학교실) ;
  • 손지웅 (건양대학교 의과대학 내과학교실) ;
  • 최유진 (건양대학교 의과대학 내과학교실) ;
  • 나문준 (건양대학교 의과대학 내과학교실) ;
  • 권선중 (건양대학교 의과대학 내과학교실)
  • Received : 2009.02.01
  • Accepted : 2009.03.06
  • Published : 2009.03.30
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Abstract

Miliary tuberculosis is quite a rare but serious cause of acute respiratory distress syndrome (ARDS). Therefore, the early detection of military tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. We report a case of military tuberculosis mimicking ARDS. A female patient was admitted due to repeated fever and dyspnea. The initial chest CT scan showed diffuse ground glass opacity, without a miliary pattern. The case was considered to be ARDS caused by pneumonia. She showed improvement after being treated with levofloxacin. However, she was re-admitted with fever seven days after discharge. The follow up chest CT scan showed micronodules in both lungs. An open lung biopsy confirmed the diagnosis of military tuberculosis.

저자들은 당뇨병의 과거력이 있는 57세 여자로 발열 및 호흡곤란을 주소로 내원하여 Mycoplasma pneumoniae에 의한 ARDS를 동반한 중증폐렴으로 오인되어 Levofloxacin 투여로 호흡곤란의 일시적인 호전 및 방사선적 소견상 호전을 보여 퇴원하였다. 퇴원 후 발열과 발한으로 시행한 HRCT 및 개흉 폐생검을 통해 속립성 결핵으로 진단되어 항결핵제 치료를 시행한 후 증상과 방사선학적 호전을 보였다. 폐렴의 치료 시 사용되는 fluoroquinolone제제의 결핵균에 대한 효과로 인해 결핵진단의 지연을 가져올 수 있어 급성 호흡곤란증후군과 같이 비전형적인 임상양상을 나타내는 속립성 결핵의 진단 시 주의를 기울여야겠다.

Keywords

References

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