Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Atypical Distribution of Pulmonary Tuberculosis in Bedridden Patient with Quadriplegia

사지마비로 장기 침상안정 환자에서 폐결핵 발생부위 변화 1예

  • Hwang, Hun-Gyu (Respiratory Division, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine) ;
  • Jung, Eun-Jung (Respiratory Division, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine) ;
  • Lim, Gune-Il (Respiratory Division, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine) ;
  • Yang, Seung-Boo (Department of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine) ;
  • Im, Han-Hyeok (Department of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine)
  • 황헌규 (순천향대학교 의과대학 구미병원 호흡기내과학교실) ;
  • 정은정 (순천향대학교 의과대학 구미병원 호흡기내과학교실) ;
  • 임건일 (순천향대학교 의과대학 구미병원 호흡기내과학교실) ;
  • 양승부 (순천향대학교 의과대학 구미병원 영상의학교실) ;
  • 임한혁 (순천향대학교 의과대학 구미병원 영상의학교실)
  • Received : 2010.04.07
  • Accepted : 2010.04.26
  • Published : 2010.07.30
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Abstract

Pulmonary tuberculosis has intermediate prevalence in Korea. It is known that tuberculosis infection predominantly involves the upper lobes, based on the fact that multiplication of Mycobacterium tuberculosis is favored in areas with decreased pulmonary blood flow, impaired lymphatic drainage, and high oxygen tension. We report this case of a 40-year-old man who was brought to our hospital with hemoptysis and dyspnea. Prior to admission, the patient had been in a bedridden state for 15 years due to an injury of the cervical spine 4~5. A 3-Dimensional computed tomography showed predominantly longitudinal distribution of centrilobular nodules along the anterior chest wall, in the left lung. MTB-PCR and AFB culture of bronchial washing fluid revealed pulmonary tuberculosis. This case shows that long-standing supine posture and decreased motion of the anterior chest wall may change the distribution of preferential infection site of Mycobacterium tuberculosis in the lung, resulting in a ventral predominance of tuberculosis infection in the quadriplegic patient.

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References

  1. World Health Organization. TB prevalence and incidence: Republic of Korea [Internet]. Geneva: World Health Organization; c2010 [cited 2010 April 1]. Available from: http://www.who.int/countries/kor/en.
  2. Meylan PR, Richman DD, Kornbluth RS. Reduced intracellular growth of mycobacteria in human macrophages cultivated at physiologic oxygen pressure. Am Rev Respir Dis 1992;145:947-53. https://doi.org/10.1164/ajrccm/145.4_Pt_1.947
  3. Perez-Guzman C, Torres-Cruz A, Villarreal-Velarde H, Vargas MH. Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes. Am J Respir Crit Care Med 2000;162:1738-40. https://doi.org/10.1164/ajrccm.162.5.2001040
  4. Cegielski JP, Chin DP, Espinal MA, Frieden TR, Rodriquez Cruz R, Talbot EA, et al. The global tuberculosis situation. Progress and problems in the 20th century, prospects for the 21st century. Infect Dis Clin North Am 2002;16:1-58. https://doi.org/10.1016/S0891-5520(03)00045-X
  5. Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol 2008; 191:834-44. https://doi.org/10.2214/AJR.07.3896
  6. Lee KS, Im JG. CT in adults with tuberculosis of the chest: characteristic findings and role in management. AJR Am J Roentgenol 1995;164:1361-7. https://doi.org/10.2214/ajr.164.6.7754873
  7. Chan CH, Woo J, Or KK, Chan RC, Cheung W. The effect of age on the presentation of patients with tuberculosis. Tuber Lung Dis 1995;76:290-4. https://doi.org/10.1016/S0962-8479(05)80026-7
  8. Umeki S. Comparison of younger and elderly patients with pulmonary tuberculosis. Respiration 1989;55:75-83. https://doi.org/10.1159/000195709
  9. Houben EN, Nguyen L, Pieters J. Interaction of pathogenic mycobacteria with the host immune system. Curr Opin Microbiol 2006;9:76-85. https://doi.org/10.1016/j.mib.2005.12.014
  10. MacGregor RR. Tuberculosis: from history to current management. Semin Roentgenol 1993;28:101-8. https://doi.org/10.1016/S0037-198X(05)80099-9
  11. West JB, Dollery CT. Distribution of blood flow and ventilation-perfusion ratio in the lung, measured with radioactive carbon dioxide. J Appl Physiol 1960;15: 405-10. https://doi.org/10.1152/jappl.1960.15.3.405
  12. Anthonisen NR, Milic-Emili J. Distribution of pulmonary perfusion in erect man. J Appl Physiol 1966;21:760-6. https://doi.org/10.1152/jappl.1966.21.3.760
  13. Goodwin RA, Des Prez RM. Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung. Chest 1983;83:801-5. https://doi.org/10.1378/chest.83.5.801