血液透析導入時に粟粒結核が顕性化した末期腎不全患者の１例

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  • A case of miliary tuberculosis developed in a patient with chronic renal failure after initiation of hemodialysis therapy

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We present a case of miliary tuberculosis, who developed after initiation of hemodialysis therapy. An 80-year-old man with end stage renal failure due to nephrosclerosis was admitted to our hospital on July 23, 2001, and hemodialysis therapy was initiated on the second hospital day. Despite the administration of antibiotics, he had fever and positive C-reactive protein. Although chest radiograph on admission showed almost normal findings, that on the 14th hospital day demonstrated diffuse small miliary shadows in bilateral lung field. Thereafter, tubercle bacilli were found in a sputum smear. The administration of antituberculosis drugs was initiated, and he was transferred to an isolation ward in the general hospital on the 29th hospital day. The patient responded promptly to the antituberculous therapy with remission of fever, but died about 2 months later.<br>In patients with end-stage renal failure, the morbidity and mortality of tuberculosis, in particular miliary tuberculosis, is reported to be much higher than in general population. Because of their impaired immunity, if a diagnosis of tuberculosis is highly suspected, early therapeutic trial of antituberculosis drugs should be given.

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