In vitro and in vivo cellular immunity in anergic miliary tuberculosis.
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We studied the hemodynamic behavior of the pulmonary circulation at rest and during exercise in six patients with MTB. As a group, in contrast to advanced fibrocaseous tuberculosis, these patients exhibited normal pulmonary hemodynamics at rest and during exercise. Only minor abnormalities in pulmonary vascular resistance at exercise (increased PAd-PWP gradient) were noted in two of the patients. The increase in Rp during exercise does not appear to be related to acute hypoxic vasoconstruction but rather to functional changes (compliance or recruitment or both) of the pulmonary microvasculature. In the genesis of these functional changes, chronic alveolar hypoxia and the inflammatory-fibrotic process might be interacting.
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A 69-year-old man with a 10-year history of diabetes mellitus and 1-year history of steroid treatment for nonspecific interstitial pneumonia presented with a nightly fever of over 39 degrees C after surgery for a false abdominal aortic aneurysm. Hypercalcemia was detected, despite acute renal dysfunction. There was no laboratory evidence of collagen disease or infection including tuberculosis. Polymerase chain reaction (PCR)-based amplification of DNA from a bone marrow biopsy specimen revealed Mycobacterium tuberculosis. Antituberculous chemotherapy was initiated. Early bone marrow biopsy and the use of new techniques such as PCR can avoid delay in initiating the proper treatment for compromised patients.