キーワーズ ADA はじめに. 1 Table % 1) Table 2 対象と方法 CA125 2 ADA. Kekkaku Vol. 86, No. 4: 431_436, 2011

Transcription

1 Kekkaku Vol. 6, No. 4: 43_436, 要旨 ADA 2 7 INH RP 3 PZA ADA キーワーズ ADA はじめに 結 果 % ) 2) 対象と方法 Table Table 2 CRP CA ADA 2 37 _ _ y.yoneshima@gmail.com Received 4 Jun. 200/Accepted 6 Dec. 200

2 Table Main clinical features Case Age Sex Clinical symptoms Underlying disease Past history of TB Abdominal lesions Other organs involved by TB Time to treatment Treatment Prognosis 66 Abd. distention Diabetes 57 days, PZA 2 7 M ever Old cerebral infarction, Intestinal TB Pleura 0 days Died 3 74 Lung Ca Lung NA, PZA days, PZA 5 2 M ever Cough day, PZA 6 7 Abd.distention Pleura 2 days 7 70 Abd.distention Diabetes OMI 35 days 0 M Abd.distention Diabetes, CR Prostate Ca, Intestinal TB Tuberculous lymphadenitis Lung 26 days TB: tuberculosis, : tuberculous peritonitis, OMI: old myocardial infarction, CR: chronic renal failure, NA: not available INH: isoniazid, RP: rifampicin, : ethambutol, PZA: pyrazinamide Table 2 Laboratory data Blood Ascitic fluid Case WBC (/mm 3 ) Lym (/mm 3 ) Alb (mg/dl) T-Cho (mg/dl) ChE (IU/l) CRP (mg/dl) ESR (mm) CA25 (U/ml) ADA (U/l) CA25 (U/l) BMI Basis of diagnosis Clinical diagnosis Bacteriology Histology Bacteriology Histology Elevation of ADA Elevation of ADA Bacteriology ADA: adenosine deaminase activity cut off U/l 2) 3) CA Table 2 BMI Table 3 ig. CT mm 5 mm 6 CT Case 3 Case 5 Ziehl-Neelsen ADA PCR Case 4 2 Case 2 Case ADA 2 Case 6

3 Tuberculous Peritonitis/S.Yoneshima et al. 433 Table 3 Abdominal CT findings Case Enhanced Ascites Small Small Small/Abscess Large Large Large *Mesenteric thickening Mesenteric micronodules NA Mesenteric macronodules *Thin lines along course of mesenteric vessels representing thickened mesenteric leaves <5 mm in diameter 5 mm in diameter NA: not available Low density center Peritoneal thickening Irregular Splenic abnormality Splenomegaly Calcification Case 7 Case 6 Case 4 Case 3 ADA 3 Case Case 5 Case 7 Case 2 Case ADA Case INH RP SM PZA 4 4 INHRP (A) (B) ig. Contrast-enhanced CT scan of case no.2 shows peritoneal smooth uniform thickening (arrows) (A) and thin lines (arrowheads) along mesenteric vessels representing thickened mesenteric leaves (B). 9

4 Case 550 ml Case 6 00 ml Case 000 ml 考 % ) 3 0% 20 50% 4) 5) ) CRP ADA 4) 7) 3 CA25 2 CA25 CA25 ) 0) CA25 察 CA 25 2 CA25 BMI BMI 2 Ziehl-Neelsen 3 3 ADA 2 2 ) ADA 2) 3) 6 2) g 2 IVH 20% 3) 4) 5) 3 7) CT 6) )

5 Tuberculous Peritonitis/S.Yoneshima et al ) 5 mm micronodules 6 6) 7) 5mm macronodules 7) 7 7) 4) 2) 0) ) 9) 20) ADA ) 9) 20) ADA 文献., 4,,,, 2006, 27 _ Bhargava DK, Gupta M, Nijhawan S, et al. : Adenosine deaminase (ADA) in peritoneal tuberculosis : diagnostic value in ascitic fluid and serum. Tubercle. 990 ; 7 : 2 _ Voigt MD, Kalvaria I, Trey C, et al.: Diagnostic value of ascites adenosine deaminase in tuberculous peritonitis. Lancet. 99 ; : 75 _ ; 60 : 96 _ 9. 5 Marshall JB: Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 993 ; : 99 _ Chen HL, Wu MS, Chang WH, et al.: Abdominal tuberculosis in southeastern Taiwan: 20 years of experience. J ormos Med Assoc ; 0 : 95 _ 20. 7,,, ; 27 : 7 _ 77. Miranda P, Jacobs AJ, Roseff L, et al.: Pelvic tuberculosis presenting as an asymptomatic pelvic mass with rising serum CA-25 levels. J Reprod Med. 996 ; 4 : 273 _ ,,,, CA ; 35 : 96 _ Adenosine Deaminase ADA ; : 03 _ 07.,,, ; : 225 _ , 2,,,, 2004, _ 9. 3,,,.. 96 ; 6 : 243 _ Tanrikulu AC, Aldemir M, Gurkan, et al.: Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey. J Gastroenterol Hepatol ; 20 : 906 _ ,,, ; 34 : 47 _ Na-ChiangMai W, Pojchamarnwiputh S, Lertprasersuke N, et al.: CT findings of tuberculous peritonitis. Singapore Med J. 200 ; 49 : 4 _ Ha HK, Jung JI, Lee MS, et al.: CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis. Am J Roentgenol. 996 ; 67 : 743 _ 74.,,, CT ; 53 : 52 _ , ; 2 : 75 _ ,,,, ; 05 : 23 _ 29.

6 Original Article CLINICAL REVIEW O PATIENTS WITH TUBERCULOUS PERITONITIS Satoko YONESHIMA, Nobuhiko NAGATA, 2 Hiroyuki KUMAZOE, Akira KAJIKI, Katsuyuki KATAHIRA, Kyouko OKAMURA, Harutaka OMURA, Kazuhito TAGUCHI, Takahiro MINAMI, Kentaro WAKAMATSU, and Yoshinari KITAHARA Abstract [Objective] With the progress of anti-tuberculous therapy, tuberculous peritonitis () has become a rare manifestation of active tuberculosis. Its early diagnosis is difficult due to lack of pathognomonic findings and specific symptoms. However, early diagnosis is important for effective treatment and for reducing fatality. [Materials and Method] We retrospectively reviewed medical records of eight patients who were hospitalized with in National Hospital Organization Omuta National Hospital during the periods between 200 and [Results] Three patients were males and five were females. The age of the patients ranged between 2 and 0 years old (average 67.3 years). The most common presenting findings were abdominal distention seen in four patients and loss of appetite in five patients. Blood examination suggested that most patients were in poor nutrition. Three patients were diagnosed based on bacteriological examination, two based on histopathological findings of caseating granulomas, two based on the elevation of adenosine deaminase activity in ascitic fluid and one based on clinical diagnosis. The most common CT findings were thin lines along mesenteric vessels representing thickened mesenteric leaves and smooth uniform peritoneal thickening. Most patients were treated with isoniazid, rifampicin and ethambutol for 9 months with/without pyrazinamide initially. Seven patients completed anti-tuberculous therapy successfully and were cured. However, one patient died of the deterioration of tuberculosis. [Conclusion] should be considered for diagnosis, in patients with non-specific abdominal symptoms. Adenosine deaminase activity in ascitic fluid and CT images are considered to be useful for the diagnosis of in patients in whom bacteriological and histopathological examinations are difficult to perform. Key words: Tuberculous peritonitis, Peritoneal tuberculosis, Clinical finding, Diagnosis, ADA Department of Respiratory Medicine, 2 Department of Radiology, National Hospital Organization Omuta National Hospital Correspondence to: Satoko Yoneshima, National Hospital Organization Omuta National Hospital, 044 _, Tachibana, Omuta-shi, ukuoka 37 _ 09 Japan. ( y.yoneshima@gmail.com)