[A case of miliary tuberculosis complicated with a tuberculous aneurysm of the aorta].

A 68-year-old man was admitted because of fever and weight loss. A chest high-resolution computed tomography (HRCT) scan revealed diffuse micronodular shadows, and an abdominal CT scan showed an aneurysm spreading from the root of the renal artery to the iliac bifurcation. His fever subsided without treatment and his general condition was good. However, histological studies of a transbronchial lung biopsy specimen and bone marrow aspirate clot revealed non-necrotizing epitheloid granulomas, and mycobacterium tuberculosis was cultured from sputum and bronchoalveolar lavage fluids. Military tuberculosis was diagnosed. One month after the initiation of chemotherapy, the abdominal aneurysm enlarged quickly despite the improvement of the thoracic findings, and graft replacement was performed. Histological findings in specimens of the resected aneurysm suggested that tuberculous inflammation of the surrounding lymph nodes had invaded the aortic wall, leading to the aneurysm. It should be borne in mind that symptoms in elderly patients with miliary tuberculosis may be mild, even when serious extrapulmonary lesions are present.

[An elderly patient with advanced non-small-cell lung cancer that responded remarkably to combination chemotherapy of vinorelbine and gemcitabine].

A 73-year-old man was admitted to our hospital because of hemoptysis in November 1999. A chest CT revealed a mass shadow in the right upper lobe and enlarged hilar and pretracheal lymph nodes. Bone scintigraphy showed a bone metastasis in right middle rib. He was treated with vinorelbine (25 mg/m2 days 1,8) and gemcitabine (800 mg/m2 days 1,8) every 3 weeks from December 1999. After 4 courses of chemotherapy, the primary tumor and hilar lymph node were remarkably reduced in size, and his hemoptysis disappeared and body weight increased. It is suggested that combination chemotherapy with vinorelbine and gemcitabine is effective for elderly patients with non-small-cell lung cancer with good performance status.