The Korean Journal of Medicine

  • 제83권1호
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  • Pages.87-92
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  • 2012
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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역설적 반응에 의하여 발생한 결핵성 간농양 1예

Development of a Tuberculous Liver Abscess as a Paradoxical Response

  • 정성웅 (한림대학교 의과대학 내과학교실) ;
  • 김진배 (한림대학교 의과대학 내과학교실) ;
  • 최종수 (한림대학교 의과대학 내과학교실) ;
  • 이경민 (한림대학교 의과대학 내과학교실) ;
  • 신수린 (한림대학교 의과대학 내과학교실) ;
  • 박상훈 (한림대학교 의과대학 내과학교실) ;
  • 이명석 (한림대학교 의과대학 내과학교실)
  • Jung, Sung-Woong (Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine) ;
  • Kim, Jin-Bae (Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine) ;
  • Choi, Jong-Soo (Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine) ;
  • Lee, Kyung-Min (Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine) ;
  • Shin, Su-Rin (Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine) ;
  • Park, Sang-Hoon (Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine) ;
  • Lee, Myung-Seok (Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine)
  • 발행 : 2012.07.01
⟨ 이전 논문 다음 논문 ⟩

초록

역설적 반응은 적절한 항결핵제로 치료하여 임상적 호전을 보이는 결핵 환자에서 치료 당시의 결핵병변이 악화되거나 또는 새로운 병변이 발생하는 경우를 말한다. 이는 약제 내성이나 치료 실패와의 감별이 필요하다. 저자들은 장 및 복강 결핵에 대한 항결핵제 치료로 임상적 호전을 보이며 원발부위의 영상검사 소견도 호전되는 상황에서 치료 2개월째 역설적 반응으로 간농양이 발생하여 지속적인 약물치료에도 호전되지 않아 수술을 시행한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Tuberculous liver abscesses are rare. We report here a case of tuberculous liver abscess that developed in a paradoxical response during appropriate anti-tuberculosis chemotherapy in a 50-year-old male. In this case, a paradoxical response to the treatment of intestinal tuberculosis may have been involved in the pathogenesis of the liver abscess.

키워드

참고문헌

  1. Hung SC, Chang SC. New pulmonary lesions during therapy for extrapulmonary tuberculosis. Chest 1999;116:1794-1797. https://doi.org/10.1378/chest.116.6.1794
  2. Onal IK, Bayraktar Y, Unal S. Paradoxical deterioration during the course of antituberculous treatment. J Natl Med Assoc 2006;98:954-955.
  3. Ahn TH, Han YJ, Kang SW, et al. A case report of tuberculous brain abscess and tuberculous peritonitis developing due to paradoxical reactions. Tuberc Respir Dis 2009;66:457-462. https://doi.org/10.4046/trd.2009.66.6.457
  4. Hwang SW, Kim YJ, Cho EJ, et al. Clinical features of hepatic tuberculosis in biopsy-proven cases. Korean J Hepatol 2009;15:159-167. https://doi.org/10.3350/kjhep.2009.15.2.159
  5. Cheng VC, Ho PL, Lee RA, et al. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis 2002;21:803-809. https://doi.org/10.1007/s10096-002-0821-2
  6. Al-Majed SA. Study of paradoxical response to chemotherapy in tuberculous pleural effusion. Respir Med 1996;90:211-214 https://doi.org/10.1016/S0954-6111(96)90289-9
  7. Kim SH, Chung HY, Lee GD, et al. Clinical characteristics of paradoxical response to chemotherapy in pulmonary tuberculosis. Tuberc Respir Dis 2002;53:27-35.
  8. Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-662. https://doi.org/10.1164/rccm.167.4.603
  9. Toossi Z, Young TG, Averill LE, Hamilton BD, Shiratsuchi H, Ellner JJ. Induction of transforming growth factor beta 1 by purified protein derivative of Mycobacterium tuberculosis. Infect Immun 1995;63:224-228.
  10. Marshall BG, Chambers MA. Central nervous system tuberculosis: the paradox of the host immune response. J Infect 1998;36:3-4. https://doi.org/10.1016/S0163-4453(98)92838-9

피인용 문헌

  1. The Species Diversity and Distribution of Vespidae in Southeast Region (Sangdong-eup, Gimsatgat-myeon, Jungdong-myeon) of Yeongwol-gun, Gangwon-do, Korea vol.5, pp.4, 2012, https://doi.org/10.7229/jkn.2012.5.4.305
  2. A Case of Tuberculous Liver Abscess Developed during Chemotherapy for Tuberculous Peritonitis as Paradoxical Response vol.62, pp.1, 2012, https://doi.org/10.4166/kjg.2013.62.1.64