一个诊断难题:揭示免疫功能低下患者肺结核外周炎
André Pereira1, Inês Peixoto2, Ana Silva3
1Internal Medicine, Unidade Local Saúde Alto Ave, Guimarães, PRT.
Cureus
|November 10, 2025
概括
在艾滋病毒患者中诊断腹部结核病 (TB) 是一个挑战. 腹膜活检对于确定诊断至关重要,当液体检测没有确定性时,可以及时治疗和恢复.
科学领域:
- 传染性疾病 传染性疾病
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
背景情况:
- 结核病 (TB) 是一个全球性的健康问题,肺外结核病,特别是腹部结核病,造成诊断困难.
- 腹部结核病呈现无特异性,并且难以诊断,特别是在像艾滋病毒感染者这样的免疫受损个体中.
- 艾滋病毒阳性患者可能不会表现出经典的结核病症状,延迟诊断和治疗.
研究的目的:
- 突出艾滋病毒阳性患者腹部结核病的诊断挑战.
- 强调侵入性诊断方法的重要性,当常规测试是负面的.
- 强调需要在免疫功能低下的人群中早期诊断和治疗腹部结核病.
主要方法:
- 一个61岁的艾滋病毒阳性女性病例报告,患有无法解释的.
- 临床表现分析,实验室发现,成像 (CT扫描) 和液分析.
- 通过腹腔镜腹膜活检与Mycobacterium结核病PCR的诊断确认.
主要成果:
- 该患者呈现出炎和淋巴腺病,炎液显示淋巴细胞占主导地位,ADA升高,但结核病阴性.
- 腹膜活检显示了颗粒状炎症,并通过PCR证实了Mycobacterium结核病.
- 抗结核疗法导致了炎的完全消失和良好的临床结果.
结论:
- 由于非典型的表现,艾滋病毒患者的腹部结核病诊断很困难.
- 性流体腺脱氨酶 (ADA) 是支持性的,但腹活检是不确定的病例的黄金标准.
- 及时诊断和治疗腹部结核病对于管理免疫功能低下的患者和预防并发症至关重要.
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