It is well known that the initial symptoms of plumonary tuberculosis slight fever,
cough and sputum or hemoptysis, even though we open find asymptomatic patients.
On the other hand, it was also reported previously by Pottenger & Pagel that some
patients complain of neurotic symptoms in the beginning of tuberculosis.
The following patient whom the author has had experience in the past, may be
presented as a possible case of this condition.
The patient suffered from insomnia and pain in the shoulder in jury '55. X-ray and
laboratory tests including sputum examination showed no pathalogical changes.
The patients was diagnosed as neurosis by his attending doctor at that time.
A 2nd chest X-ray was taken in November '56 and revealed small densities in both
upper lung fields.
Many efforts have been made by prof. KOGA, Jikeikai School Medicine, to establish
the diagnosis of early tuberculosis beginning with neurotic symptoms so-called "Koga's
Camouflaged tuberculosis" before showing abnormalities on the chest X-ray & sputum
examination.
This research has obtained successful results recently.
The neurotic symptoms in the beginning of early tuberculosis are explained as one
Selye's "General Adaptation Syndrome".
Selye reported that in the presence of emotional stress or other factors, the adrenal
cortex excretes hormones.
This phenomenon results in disharmony in the vegetative nerve system and brings
various symptoms.
Infection from tubercle bacilli may be a factor of stress to case hyperfunction of
adrenal glands.
It is obvious from the view point of Selye's theory that various symptoms such as
fever, easy fatiguability or neurotic symptoms in the early stage of tuberculosis are
general adaptation syndrome.
At Koga's clinic, experimentally they demonstrated a conspicuous image of
hyperfunction of the adrenal cortex of rats under emotional stress by the device of
"Setting Cat on Rat".
Also anther encouraging result was reported from the clinic concerning tubercle bacilli
inoculation into the abdominal cavity of guiea pigs.
Modern method of diagnosis for tuberculosis such as chest x-ray and sputum
examination are not satisfactory to find so-called camouflaged tuberculosis.
The most important method is the examination of eye funds to find chronic
retrobulbar optic neuritis.
Many theories have been reported about the cause of optic neuritis.
Dr. Saigo Koga clinic, reported 70% of optic neuritis among 80 patients suspected of
so-called camouflaged tuberculosis.
A late experimental report concerning electromicroscopic findings of the optic nerve
after B.C.G. inoculation into the abdominal cavity of mouse was encouraging.
As to the treatment there is no difference between tuberculosis and so-called
Camouflaged tuberculosis.
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