(Vol.73 No.10 Octber 1998) <1> Kekkaku Vol.73,No.10:579-584,1998 CLINICOPATHOLOGICAL STUDY OF CASES WITH MYCOBACTERIUM SZULGAI INFECTION Tomoaki IWANAGA*, Reiko KISHIKAWA, Togo IKEDA, Takahito HIROSE, Hideto TSURUTANI and Shoko YOSHIDA Pulmonary mycobacteriosis is usually caused by Mycobacterium tuberculosis, Mycobac- terium avium complex, or Mycobacterium kansasii. There are, however, other slow-grow- ing mycobacteria which can cause pulmonary infection. Mycobacterium szulgai, first reported in 1972, is a scotochromogenic species which can affect human lungs, although human-to-human spread of infection is thought to be unlikely. We have recently treated three cases of middle-aged to elderly persons(45`87 year-old), two of them had under- lying diseases (one with intrapulmonary and the other with extrapulmonary). All pa- tients had constitutional symptoms (cough, sputum, dyspnea), and chest roent- genograms demonstrated either cavitation with scattered nodules or peripheral infiltrates predominantly in upper lobes, resembling pulmonary tuberculosis. In two cases, M.szulgai was identified by using DNA-DNA hybridization method. The in vitro susceptibility of M.szulgai to antimycobacterial drugs was better than that of M.avium complex, and it was resistant only to paraaminosalicylate, cycloserine, and partially to isoniazid. Pul- monary disease of three patients were successfully treated with a combination of multi- ple antimycobacterial agents including rifampin, ethambutol, isoniazid, or streptomycin. Key words: Atypical mycobacteriosis, Nontuberculous mycobacteriosis, Mycobacterium szulgai, Slow-growing mycobacteria, Antimicrobial susceptibility test *From the pulmonary Medicin, National Minami-Fukuoka Chest Hospital, Fukuoka 811-1394 Japan. (Received 14 May 1998/Accepted 11 Jun. 1998) <2> Kekkaku Vol.73,No.10:585-590,1998 SIGNIFICANCE OF SERUM SURFACTANT PROTEIN-D(SP-D)LEVEL IN PATIENTS WITH PULMONARY TUBERCULOSIS Ariyoshi KONDO*, Norihiro OKETANI, Michio MARUYAMA, Youko TAGUCHI, Yoshibumi YAMAGUCHI, Hiromi MIYAO, Ichiro MASHIMA, Michiko OONO, Kouichi WADA, Toshimasa TSUCHIYA, Hiroki TAKAHASHI and Shousaku ABE Elevated levels of serum surfactant protein-D(SP-D) have been previously reported in patients with idiopathic pulmonary fibrosis(IPF) and pulmonary alveolar proteinosis. To determine whether the same change is seen in other pulmonary diseases, especially pul- monary tuberculosis(TB), we measured the serum SP-D levels in active pulmonary TB (smear and/or culture:positive), acute interstitial pneumonia(AIP), IPF, acute exacer- bation of IPF, hypersensitivity pneumonitis(HP), pneumoconiosis, bronchiectasis, and bacterial pneumonia by an enzyme-linked immunosorbent assay using monoclonal anti- bodies to human lung SP-D, and compared them with those of healthy elderly subjects over 50 years of age. The SP-D level in the healthy elderly subjects was 57.6}38.4ng/ml(mean}SD, n=287). The levels in patients with active pulmonary TB(140.6}18.2ng/ml, n=49), AIP (1,021ng/ml, n=1), IPF(307.0}180.7ng/ml, n=42), acute exacerbation of IPF(817.7} 283.6ng/ml, n=3), and HP(716.6}548.8ng/ml, n=4)were significantly higher than those in the healthy elderly controls (p<0.05), whereas those of pneumoconiosis, bronchiectasis, and bacterial pneumonia, 121.9}92.8ng/ml(n=8), 93.9}72.9ng/ml(n=11), and 72.7}3.4 ng/ml(n=4), respectively, showed no significant difference with the controls. In active pulmonay TB, the percentage of patients whose serum SP-D levels were over 134.6ng/ml(mean+2SD of healthy elderly controls) was 34.7%, and therfore we consid- ered the serum SP-D level was not useful for the diagnosis of pulmonary TB. However, it was significantly higher in the patients with cavity formation than in those without (p<0.05), and there was a significant positive correlation between the serum SP-D level and the number of tubercle bacilli in the sputum(r=0.416, p=0.00165), erythrocyte sedimen- tation rate at 1hr(r=0.489, p<0.01), and CPR level (r=0.383, p=0.003). These findings suggest that the serum SP-D level is a useful indicator of the disease activity in pulmonary TB. Key words: Serum surfactant protein-D(SP-D), Active pulmonary tuberculosis, Healthy elderly subjects. Idiopathic pulmonary fibrosis(IPF) *From the Department of Respiratory Medicine, National Sanatorium Nishi-Niigata-Chuo-Byoin, 1-14-1 Masago, Niigata-shi, Niigata 950-2085 Japan. (Received 26 Jan. 1998/Accepted 17 Jun. 1998) <3> Kekkaku Vol.73,No.10:591-597,1998 A CASE OF MILIARY TUBERCULOSIS WITH BRAIN TUBERCULOMA, FOLLOWING INTRAOCULAR TUBERCULOSIS Shunji TAKAKURA*, Eisaku TANAKA, Terumi KIMOTO, Isao WATANABE, Hisako MATSUMOTO, Kazunari TSUYUGUCHI, Akio NIIMI, Katsuhiro SUZUKI, Ryoichi AMITANI and Fumiyuki KUZE A 52-year-old woman with visual loss of her left eye consulted a ophthalmology clinic. She was conducted left vitrectomy and administered corticosteroid under the diagnosis of uveitis of unknouwn cause. But her visual acuity was not improved. Although re-surgery was planned, pus retention was found in her left eye. After her left eye was resected, fever and general malaise appeared suddenly. Her chest X-ray film revealed diffuse micronodular opacities. Acid-fast bacilli were detected from her sputum and identified to be Mycobacterium tuberculosis. She was diagnosed miliary tuberculosis, and then antituberculous chemotherapy consisting of 4 drugs was started. Granulomatous inflam- mation destructing retina and numerous acid-fact bacilli were found in histologic exsamina- tinon of the resected eye. This case was thought to be miliary tuberculosis disseminated from intraocular tuberculosis. After 2 months of therapy, neurologic symptoms which might be caused by brain tuberculoma appeared and deteriorated rapidly. But by adding corticosteroid to antituberculous therapy, symptoms were diminished gradually. Key words: Intraocular tuberculosis, Miliary tuberculosis, Brain tuberculoma, Corticosteroid, Magnetic resonance imaging *From the Department of Pulmonary Medicine, Kobe City General Hospital, 4-6 Minatojima-nakamachi, Chuo-ku, Kobe 650-0046 Japan. (Receuved 26 Mar. 1998/Accepted 1 Jul. 1998)