Impression Initial plan 1. Endobronchial Tb Initial plan 1. chest CT 2. bronchoscopy 3. Tb culture, AFB stain, MTB PCR 4. quantiFERON-gold

Chest CT

Chest CT

Rt bronchus intermedius brochoscopy (2/15) Rt main bronchus Rt bronchus intermedius Mass 직하방

brochoscopic biopsy (2/15) bronchial fluid AFB stain (-) AFB stain culture (-) MTB PCR (-) sputum MTB PCR (-) MTB PCR hybridization (-) brochoscopic biopsy (2/15) bronchial mucosa showing caseous necrosis and granulomatous inflammation consisted of epitheloid hystiocytes and lymphocytes with Langhans giant cell. No evidence of malignancy is seen. Tuberculosis, consistent with, Special stain finding: A.F.B(-) quantiFERON-gold (2/16) positive

Case 3 기침과 가래를 주소로 내원한 50대 남성 Chief complaint Present illness adm 07-3-5 Chief complaint cough o/s ) 2개월 전 Present illness 9년 전 폐결핵 진단받고 보건소에서 약 복용 후 완치판정 받은 자로 2개월 전부터 기침 지속되어 촬영한 chest CT 에서 endobronchial Tb 의심되어 정밀검사 위해 내원 Past medical history DM/HTN/Tb/hepatitis (+/+/+/-) DM: 20년 전부터 medication, 현재 metformin+insulin HTN: 1년전 medication, unstable angina: 2006.2 CAG & PTCA(prox.LAD) Personal history Smoking ( + ): 30 PY Alcohol ( + ) : 3회/주, 소주 1~2병

Review of System Physical Examination General fatigue (+) febrile sense (-) chilling (-) myalgia (+) weight loss(-) night sweating (-) Head & Neck headache(+): 현재는 경감 nasal obstruction(+) rhinorrhea(+) Respiratory cough (+) sputum (-) tachypnea (-) Cardiac chest pain (-) palpitation (-) orthopnea (-) DOE(+) Physical Examination Vital sign 120/80mmHg- 76/min- 24/min-36.5’C General alert mentality not so ill looking appearance Thorax clear breath regular heart beat withour murmur

Initial lab finding CBC/DC 4510/mm² -14.9 g/dl – 42.4 %- 262K (seg : 77.8%) aPTT 39.5/34 sec PT(INR) 13.3S100C13.3 (1.00 ) Chemistry TB/DB 0.52/0.08 mg/dL AST/ALT 29/23 U/L ALP/GGT 81/25 U/L protein/alb 6.2/3.1 g/dL LD/CK 465/54 U/L BUN/Cr 13/0.6 mg/dL Na/K/Cl 134/3.9/95 mmol/L UA RBC 0-1/HPF WBC 0-1/HPF

Chest X ray 2005.9.24 2007.1.26

Chest CT 2005.2.2 2007.2.20

Impression Initial Plan 1. endobronchial tuberculosis Initial Plan 1. Tb culture, AFB stain, MTB PCR 2. bronchoscopy 3. quantiFERON-gold

Clinical course Plan * sputum AFB stain (-) AFB stain culture(-) MTB PCR (-) cytology : within normal limit * endoscopy : no endobronchial lesion * quantiFERON-gold : positive Plan HERZ 시작