摘要
這位24歲女性慢性咳嗽和呼吸困難己有五個月之久。雖然以前並沒有氣喘病史，卻接受吸入型類固醇及擴張劑治療。間隔五個月的胸部X光片並沒有發現任何明顯病灶。兩次痰液檢查並沒有發現結核菌。支氣管鏡檢查顯示左主支氣管明顯狹窄且可見乳酪狀塊狀物填塞左上葉氣管的共同開口氣管內塊狀物完全阻塞了左肺舌葉的支氣管。從支氣管鏡抽出的痰液經鏡檢可見結核菌。經支氣管鏡所作氣管內切片証實了支氣管內結核。對於這種呈現出活動性乳酪狀病變的支氣管內結核，我們採用了複合型抗結核菌藥物治療，抗結核菌藥物治療後六個月，再重作支氣管鏡檢查顯示左上葉支氣管開口處的乳酪狀病變已經消失，而且和抗結核菌藥物治療前的支氣管鏡檢查比較，左主支氣管僅呈現輕微狹窄。理學檢查並沒有單側肺部之喘鳴聲。
並列摘要
A 24-year-old female had suffered from chronic cough and dyspnea for five months. She was treated as bronchial asthma though there was no previous history of this condition. Serial chest radiographs within a five-month period had demonstrated no definite lesion. Physical examination revealed localized wheezing in the left hemithorax. However, two sputum examinations did not reveal acid-fast bacilli. Fiberoptic bronchoscopy revealed a stenotic left main bronchus with caseous material obstructing the common orifice of the upper left lobar bronchus. An endobronchial polypoid lesion leading to the total occlusion of the left lingular bronchus was identified. Sputum collected from the bronchoscopic examination demonstrated acid-fast bacilli, and the bronchoscopic biopsy confirmed the diagnosis of endobronchial tuberculosis (EBTB). An antituberculosis regimen was administered for this actively caseating subtype of endobronchial tuberculosis. A follow-up bronchoscopy six months after antituberculosis chemotherapy demonstrated a resolution of the caseous material, and only a slightly stenotic change in the orifice of the left main bronchus. The patient was found to be free of localized wheezes upon physical examination.
延伸閱讀
- 許紋銘、壽勤勝、陳玉焜（1991）。原發性結膜結核病－病例報告。中華民國眼科醫學會雜誌，30(3)，163-166。https://doi.org/10.30048/ACTASOS.199112.0110
- Jiang, B. Y., Shieh, W. B., Huang, T. J., Hua, C. C., & Yu, T. R. (2002). 支氣管放線菌症合併肺部非結核性分枝桿菌症：病例報告及文獻回顧. 胸腔醫學, 17(2), 137-142. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200206-17-2-137-142-a
- Huang, C. T. (2018). 以支氣管鏡診斷之氣管結核病例報告. 童綜合醫學雜誌, 12(1), 55-58. https://www.airitilibrary.com/Article/Detail?DocID=20713592-201806-201806280011-201806280011-55-58
- Chuang, L. L., Lee, J. J., & Lin, C. B. (2017). 前胸壁結核菌膿瘍－病例報告. 胸腔醫學, 32(3), 125-129. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201706-201705310015-201705310015-125-129
- Chen, S. H., & Wong, K. S. (2004). 肺結核引起之咳血：一病例報告與文獻回顧. 中華民國兒童胸腔醫學會雜誌, 4(2), 151-160. https://doi.org/10.6322/JPRD.200402_4(2).0009