在艾滋病毒阴性患者治疗结核性肝后11年发生的矛盾反应:病例报告和文献综述
Kodai Suzue1, Yasuo Tanaka2, Naoki Akazawa1
1Department of Gastroenterology, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.
Clinical journal of gastroenterology
|August 31, 2025
概括
对抗结核病 (抗结核病) 治疗的悖论性反应 (PRs) 可能发生在治疗结束后很晚. 这种罕见的病例凸显了考虑PR的重要性, 以避免不必要的抗结核药物使用.
科学领域:
- 传染性疾病
- 肝病学
- 免疫学
背景情况:
- 对抗结核病 (抗结核病) 治疗的悖论性反应 (PRs) 涉及尽管初步改善,但病变恶化或出现新的病变.
- 在HIV阴性个体中,PR不太常见,并且很少以肝的形式出现.
- 结核病治疗结束后的晚期复发不常见,难以与复发区分.
研究的目的:
- 报告一种罕见的晚期发生的异常反应,表现为肝.
- 强调治疗后PR的诊断挑战和管理考虑.
- 强调在结核病治疗多年后,在差异诊断中考虑PR的重要性.
主要方法:
- 一位51岁的HIV阴性妇女的病例报告, 曾经接受过结核病治疗, 包括肝.
- 诊断工作包括计算机断层扫描,超声导向肝脏活检,组织病理学,聚合酶链反应 (PCR) 和结核培养.
- 没有进一步的抗结核治疗的临床观察.
主要成果:
- 在完成抗结核治疗11年后,该患者出现了新的肝结节.
- 肝脏活检显示有结核病的颗粒瘤,但PCR和结核病培养是负面的.
- 患者被诊断为治疗后晚期出现的PR,并观察到肝脏突自发退化.
结论:
- 在结核病治疗结束后很长一段时间后,可能会出现晚期出现的矛盾反应.
- 区分治疗后的肺结核复发和结核病复发对于适当的治疗至关重要.
- 在疑似肺结核病例中,避免不必要的抗结核药物使用是很重要的.
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