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患者女,25岁,因间断咳嗽、咯痰1周于2010年8月26日入院。患者无发热、盗汗,既往体健。入院后胸部CT检查显示左肺上叶尖后段厚壁空洞(图1A),查痰结核分枝杆菌荧光PCR阳性,血抗结核抗体阳性。支气管镜检查未见明显异常。初步诊断:继发性肺结核。给予异烟肼、利福平、吡嗪酰胺、乙胺丁醇、链霉素治疗。1个月后,痰分枝杆菌快速培养(MGIT培养)及基因测序为非结核分枝杆菌(nontuberculous mycobacteria,NTM)——蟾分枝杆菌,对链霉素、异烟肼、利福平、乙胺丁醇耐药。复查胸部CT较前无明显变化。调整用药方案为利福布丁、乙胺丁醇、莫西沙星、阿米卡星、丙硫异烟胺。2
Female, 25 years old, was admitted to hospital on August 26, 2010 due to intermittent cough and expectoration for 1 week. Patients without fever, night sweats, previous physical health. Chest CT examination after admission showed that the posterior segment of the left upper pulmonary parenchyma was empty (Fig. 1A), sputum positive for Mycobacterium tuberculosis by fluorescence PCR and positive for blood anti-TB antibody. Bronchoscopy showed no obvious abnormalities. Initial diagnosis: secondary pulmonary tuberculosis. Give isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin treatment. One month later, Mycobacterium phlei rapid culture (MGIT culture) and gene sequencing were nontuberculous mycobacteria (NTM) -subunit with streptomycin, isoniazid, rifampicin, Ethambutol resistant. Review chest CT no significant change in the previous. Regimen adjustment programs for rifabutin, ethambutol, moxifloxacin, amikacin, propylthiouracil. 2