パラアミノサリチル酸（ＰＡＳ）による甲状腺機能低下症をきたした多剤耐性肺結核症の２例

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  • Two Cases of Multi-Drug-Resistant Pulmonary Tuberculosis with Para-Aminosalicylic Acid (PAS)-Induced Hypothyroidism.
  • ショウレイ ホウコク パラアミノ サリチルサン(PAS)ニ ヨル コウジョウセン キノウ テイカショウ オ キタシタ タザイ タイセイ ハイケッカクショウ ノ 2レイ

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Two cases of multi-drug-resistant pulmonary tuberculosis with para-aminosalicylicacid (PAS)-induced hypothyroidism were reported.<BR>Case 1; a 73-year-old male, complaining of edema, was admitted to our hospital. Hehad been treated for his multirug-resistant pulmonary tuberculosis during the past 1year with an antituberculous regimen consisting of ethambutol (EB), ethionamide (ETH) and PAS. A thyroid profile performed when he was admitted to our hospital showed severalmarked abnormalities: serum thyroid stimulating hormone (TSH) was elevated (69.4 ii IU/ml: normal, 0.4-4.2 m IU/ml), free thyroxine level (T4) (0.01 ng/dl; normal, 0.70-1.60 ng/dl) and free triiodothyronine level (T3) (0.60 pg/ml; normal, 2.3-4.1 pg/ml) were low.<BR>PAS was discontinued after he was admitted to our hospital, since PAS was believed to bethe cause of the hypothyroidism. A thyroid profile that was repeated after the exclusionof PAS from treatment showed the following results: the TSH level was decreased (13.4m IU/ml), the free T4 (0.93 ng/dl) were normal. During treatment with PAS, he hadnever received thyroid replacement therapy.<BR>Case 2; A 22-year-old female, complaining of hemosputum. She had been treated forher multi-rug-resistant pulmonary tuberculosis during the past 11 months with anantituberculous regimen consisting of EB, ETH and PAS. A thyroid profile performed when she was admitted to our hospital showed several marked abnormalities: elevatedserum TSH (112.7 m IU/ml), and low T4 (2.0 μg/ dl) and T 3 (1.1 ng/ml). A thyroid profilethat was repeated after the exclusion of PAS from treatment showed the followingresults: the TSH level was decreased (5.1m IU/ml). Drug-induced hypothyroidism is aninfrequent side effect of therapy with PAS, and only a few cases of PAS-induced hypothyroidismhave been reported so far. In this report, we describe patients with hypothyroidismwho were receiving therapy for multi-drug-resistant tuberculosis, tuberculosisnamely, resistant to at least isoniazid (INH) and rifampicin (RFP), with a regimen thatcontained PAS.

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  • 結核

    結核 76 (10), 667-672, 2001

    一般社団法人 日本結核病学会

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