Abstract：
We report a case of pulmonary tuberculosis developed during chemotherapy for colon cancer. A 78-year-old man with dyspnea was referred to our hospital for the treatment of transverse colon cancer with duodenal invasion. Chemotherapy was initiated for severe respiratory dysfunction associated with emphysema. After 3 months of chemotherapy, the patient required hospitalization because of severe general fatigue and appetite loss. Pneumonia occurred on the 9th hospital day. Antibiotic therapies with cefotiam hydrochloride or tazobactam/piperacillin were ineffective, his respiratory condition gradually decreased, and thus, endotracheal intubation was required. The patient was finally diagnosed with pulmonary tuberculosis by acid-fast staining of the sputum. Antituberculosis therapy with rifampicin, isoniazid, and streptomycin was effective, and acid-fast staining became negative after 2 weeks of antituberculosis therapy. However, he could not withdraw from the ventilator support and died of cancer progression on the 94th hospital day. Because chemotherapies induce immunosuppression, a targeted screening for latent tuberculosis infection should be performed in patients with colorectal cancer who are highly at risk for tuberculosis before starting chemotherapy, and pulmonary tuberculosis should be ruled out when a patient develops symptoms of pneumonia during chemotherapy.
摘要：
我们报告了一例结肠癌化疗期间出现的肺结核。一名78岁呼吸困难的男子被转诊到我院治疗十二指肠侵犯的横结肠癌。对与肺气肿相关的严重呼吸功能障碍开始化疗。化疗3个月后，由于严重的全身疲劳和食欲不振，患者需要住院治疗。肺炎发生在医院第9天。盐酸头孢替安或他唑巴坦/哌拉西林的抗生素治疗无效，他的呼吸状况逐渐减弱，因此，需要气管插管。患者最终通过痰液的抗酸染色诊断为肺结核。利福平抗结核治疗,异烟肼,链霉素是有效的，抗结核治疗2周后，抗酸染色变为阴性。然而,他无法退出呼吸机支持，并在第94个住院日死于癌症进展。因为化疗诱导免疫抑制,在开始化疗前应对结核病高风险的结直肠癌患者进行有针对性的潜伏性结核感染筛查，当患者在化疗期间出现肺炎症状时，应排除肺结核。
