【肺癌合并活动性非结核分枝杆菌(NTM)感染1例经抗癌药物及抗NTM药物治疗成功】。

Yu Fujita, Satoru Ishii, Satoshi Hirano, Yuichiro Takeda, Haruhito Sugiyama, Nobuyuki Kobayashi
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摘要

一例55岁男性肺鸟分枝杆菌复合体(MAC)病患者因用力呼吸困难及全身疲劳而转诊至我院。胸部计算机断层扫描(CT)显示左侧S区(1+2)结节影伴胸膜压痕,左侧胸膜积液,右侧S1区为肺MAC疾病所致的厚壁腔性病变。左侧S(1+2)结节活检标本显示腺癌,各项检查证实为IV期肺腺癌(T2aN0M1a)合并活动性肺MAC病。采用利福平、乙胺丁醇、克拉霉素、链霉素组成的抗非结核分枝杆菌病(NTM)化疗治疗肺MAC病,肺癌治疗后加卡铂/培美曲塞4个疗程。这改善了患者的肺MAC疾病,肺癌进入部分缓解,没有严重的不良反应。虽然需要对药物相互作用进行更详细的分析,但我们得出结论,抗ntm和卡铂/培美曲塞联合化疗是安全有效的。
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[A case of lung cancer complicated with active non-tuberculous mycobacterium (NTM) infection successfully treated with anti-cancer agents and anti-NTM agents].

A 55-year-old man with pulmonary Mycobacterium avium complex (MAC) disease was referred to our hospital with dyspnea on exertion and general fatigue. Chest computed tomography (CT) revealed a nodular shadow with pleural indentation in the left S(1+2), left pleural effusion, and a thick-walled cavitary lesion due to pulmonary MAC disease in the right S1. A biopsy specimen of the nodule in the left S(1+2) revealed adenocarcinoma, which various examinations confirmed to be stage IV lung adenocarcinoma (T2aN0M1a) complicated with active pulmonary MAC disease. Anti-non-tuberculous mycobacteriosis (NTM) chemotherapy consisting of rifampicin, ethambutol, clarithromycin and streptomycin was administered to treat the pulmonary MAC disease, and the lung cancer was then treated with 4 courses of carboplatin/pemetrexed. This improved the patient's pulmonary MAC disease, and the lung cancer went into partial remission without severe adverse effects. Although a more detailed analysis of the drug interaction is required, we concluded that a combination of anti-NTM and carboplatin/pemetrexed chemotherapy was safe and effective.

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