眼睛和视力丧失在肺外结核与双边洞穴性鼻干涉的肺外结核
Bilal Hassouneh1, Francesco Genderini2, Joachim G Schulz3
1Department of Ophthalmology, CHU Saint-Pierre, Brussels, Belgium.
IDCases
|December 31, 2025
概括
结核病很少会影响洞穴鼻,导致神经症状. 诊断需要高度的临床怀疑,通常需要额外组织检查,因为神经影像和脑脊液测试可能是正常的.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 放射学 放射学是一门学科.
背景情况:
- 结核病 (TB) 是一个全球性的健康问题,主要影响肺部,但能够引起各种肺外表现.
- 结核病的神经参与,虽然不太常见,但可以出现严重的并发症,包括神经和脑膜炎症.
- 结核病引起的洞穴鼻腔卷入极为罕见,经常呈现非特异性临床和成像发现,造成诊断挑战.
研究的目的:
- 报告一个罕见的结核洞腔鼻综合征病例.
- 突出诊断挑战,并强调临床怀疑和可访问的活检地点的重要性,以确定诊断.
- 讨论这种罕见的结核病的治疗方法和结果.
主要方法:
- 病例报告详细介绍了一名41岁的女性患者,患有进展性神经缺陷.
- 综合诊断工作包括连续磁共振成像 (MRI),脑脊液 (CSF) 分析,QuantiFERON-TB Gold测试,18F-FDG PET-CT和淋巴结活检.
- 用四种药物抗结核疗法和皮质类固醇治疗.
主要成果:
- 最初的调查没有确定;重复的MRI揭示了洞穴鼻病变,血管炎,视觉通路干扰和脑膜炎.
- 结核病的诊断通过阳性QuantiFERON-TB Gold,PET-CT上的高代谢性阴道淋巴结以及通过Xpert MTB/RIF Ultra和淋巴结活检培养的Mycobacterium结核病检测得到证实.
- 患者通过抗结核疗法和皮质类固醇治疗呈现临床改善,神经状态对皮质类固醇剂量敏感.
结论:
- 洞穴性鼻结核是一种罕见的实体,往往没有肺部疾病和非特异性的初步发现.
- 由于神经成像和CSF分析的局限性,最终的诊断可能需要额外组织检查.
- 及时诊断和用抗结核药物和皮质类固醇治疗对于结核洞腔鼻综合征的良好结果至关重要.
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