在患有多发性肌痛性风湿症的患者中无症状的结核病
Hirokazu Taguchi1, Shuji Sumitomo1, Hideki Oka1
1Rheumatology, Kobe City Medical Center General Hospital, Kobe, JPN.
Cureus
|September 26, 2025
概括
毫叶结核病 (TB) 可以在没有典型的症状 (如发烧) 的情况下出现. 这一案例凸显了对疑似千里亚结核病的警随访的重要性,即使在无症状患者中也是如此.
科学领域:
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 千叶性结核病 (TB) 通常表现为全身性症状,这是由于广泛传播的Mycobacterium结核病.
- 低剂量普雷迪尼索隆和甲状腺等治疗的免疫抑制可以增加结核病风险.
- 多发性肌痛风湿是一种炎症状况,通常用皮质类固醇治疗.
研究的目的:
- 报告一种罕见的毫叶结核病病例,呈现无症状.
- 强调诊断方面的挑战,以及对疑似军性结核病的随访的重要性.
- 突出千里亚结核病可能发展为结核性脑膜炎的潜力.
主要方法:
- 一个87岁的老妇人的病例报告.
- 诊断工作包括胸部计算机断层扫描 (CT),横支气管肺活检 (TBLB),支气管支气管洗 (BAL) 和脑脊液 (CSF) 分析.
- 进行了培养和聚合酶链反应 (PCR) 检测Mycobacterium结核病.
主要成果:
- 在接受免疫抑制治疗的无症状患者的胸部CT上偶然发现了百万结节.
- 从肺样本中进行的初始微生物学测试 (培养,PCR) 呈阴性.
- 结核白血病的组织学显示了上皮状颗粒瘤.
- 随后发烧和昏昏欲睡,脑脊髓菌培养出Mycobacterium tuberculosis的阳性,证实结核病与结核性脑膜炎的军事结核病.
结论:
- 毫叶结核病可以无症状发生,这使得早期诊断具有挑战性.
- 负的初始微生物测试并不能排除千里亚结核病,特别是在免疫受损的个体中.
- 密切监测和随访对于疑似千里结核病患者至关重要,即使没有明显的症状,由于脑膜炎等严重并发症的风险.
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