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79 歳男性.発熱,咳嗽で発症し,鼻閉の既往,空洞を伴う両下肺の浸潤影,顕微鏡的血尿,急速進行する腎機能障害およびPR3-ANCA 高値を示し,Wegener 肉芽腫症( WG) と診断された.一時シクロフォスファミド併用を含む,高用量副腎ステロイド療法が開始され,臨床および検査所見は改善した.ステロイド薬は漸減され,3 ヶ月後にはC-ANCA は陰性化した.WG は寛解していたが,8 ヶ月後に胸部下行大動脈瘤形成を認め,その1 ヶ月後に突然大喀血し,死亡した.動脈瘤形成は疾患活動性とは関連なく,経過中注意深い観察の継続を要する., A 79-year-old man was admitted because of fever andcough. He had been diagnosed with Wegener's granulomatosis(WG) on the basis of 10-year history of stuffy nose,pulmonary infiltrates with cavity formation, rapidly progressedrenal dysfunction with microscopic hematuria, andhigh level of PR3-ANCA. He was treated with high dose ofglucocorticoid( GC) temporarily in combination with cyclophosphamide,accordingly, the clinical manifestation and thelaboratory results had been recovering. The dose of GC wastapered down, and 3 months after the initiation of therapy,C-ANCA testing was negative. Despite remission was obtained,8 months after, chest computed tomography (CT)scan showed aneurysm formation on the descending aorta.One month after that, the patient had an abrupt onset ofcoughing up a massive amount of blood, and died. Aneurysmformation may develop independently of disease activityin WG and may be unpredictable, so that a carefulobservation whether aneurysm is formed should be continuouslyconsidered in the follow-up during the entire course.

35歳男性.入院約6週前より喀痰,咳嗽出現.数日前に左上肺空洞影指摘,喀痰中抗酸菌(3+)検出され入院.INH,RFP,PZA 及びEB による標準化学療法が開始された.咳嗽,呼吸困難,両肺野狭窄音聴取及び多量排菌持続し,気管支鏡所見上気管〜両側主気管支に隆起性潰瘍病変を認め,気管支結核を確定.高度の呼吸器症状遷延のため中等量のステロイド点滴投与を開始し,症状ならびに気道粘膜病変は改善した.高率に気管・気管支瘢痕収縮へ移行しうる気道粘膜像であったが,中等量の全身ステロイド療法により回避された.気道瘢痕狭窄回避のため,気管支結核活動性病変には中等量以上の全身ステロイド療法を考慮すべきと考えられた., A 35-year-old man admitted to the hospital because of acavitary lesion in the lung and acid-fast bacilli (AFB) (3+) in a sputum specimen, a polymerase-chain-reaction ofwhich revealed positive for M. tuberculosis. He had beenwell until approximately 6 weeks before admission, whenproductive cough developed. He also had temperature of upto 38 ℃, hoarseness, and shortness of breath couple of daysbefore. Intractable cough, dyspnea, wheeze in both lungfields, and numerous AFB in a sputum sustained, despiteprompt introduction of conventional chemotherapy containingINH, rifampicin, pyrazinamide, and ethambutol. Diagnosisof EBTB was confirmed by fibroptic bronchoscopy,which revealed granulomatous ulceration in the mucosa oftrachea and both main bronchi. Accordingly, intravenousmedium-dose methylprednisolone was administered, resultingrelief from serious respiratory manifestation and avoidanceof cicatricial stenosis of trachea and bronchi. This outcomesuggested that the current early intervention withglucocorticoid should be considered in serious active lesionof tracheal and bronchial mucosa in patients with EBTB.