ABSTRACT
We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml (reference value of negative is < 14 pg/ml), Mycobacterium tuberculosis culture was positive, and tuberculin skin test (PPD) was negative (skin induration < 5 mm). The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic-predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.
Subject(s)
Aged, 80 and over , Humans , Male , Adenocarcinoma, Mucinous , Diagnosis , Pathology , Antibiotics, Antitubercular , Therapeutic Uses , Disease Progression , Lung Neoplasms , Diagnosis , Pathology , Mycobacterium tuberculosis , Positron Emission Tomography Computed Tomography , Pulmonary Alveoli , Pathology , Tuberculosis, Pulmonary , Diagnosis , Drug TherapyABSTRACT
OBJECTIVE:To investigate therapeutic efficacy and safety of linezolid and teicoplanin in the elderly patients with severe MRSA infection. METHODS:97 elderly patients with severe MRSA infection were collected and divided into linezolid group (42 patients) and teicoplanin group (55 patients). Linezolid group was given linezolid 600 mg intravenously,bid;teico-planin group was given teicoplanin 400 mg intravenously,qd,double dose for the first day. Treatment course lasted for 7-21 d. Clin-ical effective rate,bacterium clearance rate and ADR were compared between 2 groups after treatment. RESULTS:The bacterium clearance rate of teicoplanin group was 52.6%,and that of linezolid group was 73.5%;the linezolid group was significantly higher than the teicoplanin group,with statistical significance(χ2=12.57,P=0.034). Clinical effective rate was 78.6% in linezolid group and 58.2% in teicoplanin group;the linezolid group was significantly higher than the teicoplanin group,with statistical significance (χ2=9.56,P=0.018). After 14 days of treatment,APACHEⅡ score of teicoplanin group and linezolid group were (14.56±3.04) and(10.29±4.84),respectively;the teicoplanin group was lower than the linezolid group,with statistical significance(t=10.97, P=0.014). The incidence of ADR was 11.9% in linezolid group and 20.0% in teicoplanin group,with statistical significance(χ2=1.13,P=0.287). CONCLUSIONS:Linezolid has superior curative effect to teicoplanin in the treatment of severe MRSA infection in elderly patients with good safety.