上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (4): 526-.doi: 10.3969/j.issn.1674-8115.2013.04.032

• 病例报告 • 上一篇    

以肝脾冷脓肿为首发症状的结核病一例报道

张秋蕊1, 陈 虹1, 周 敏1, 何 平2   

  1. 上海交通大学 1.医学院附属瑞金医院呼吸科, 上海 200025； 2.基础医学院病原微生物实验室, 上海 200025
  • 出版日期:2013-04-28 发布日期:2013-05-03
  • 作者简介:张秋蕊（1986—）, 女, 硕士生； 电子信箱: zhangrui19870822@163.com。

One case report of tuberculosis with liver and spleen cold abscesses as initial symptom

ZHANG Qiu-rui1, CHEN Hong1, ZHOU Min1, HE Ping2   

  1. 1.Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China； 2.Department of Medical Microbiology and Parasitology, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-04-28 Published:2013-05-03

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摘要：

以肝脾冷脓肿为首发症状且累及全身多器官的结核病较为少见。文章报道1例以肝脾冷脓肿为首发症状的结核病患者的诊断和治疗过程。根据患者症状、体征及脾切除后的病理学检查和CT检查结果，综合分析结核病可能性较大，试行诊断性抗结核联合抗感染治疗，2周后患者体温降至正常，提示治疗有效。此后，穿刺液和分泌物培养结核分枝杆菌阳性,菌落PCR扩增及核苷酸测序证实为结核分枝杆菌感染。因此，在高度怀疑结核分枝杆菌感染的情况下，可试行诊断性抗结核治疗（联合治疗），影像学检查在辅助诊断结核病的过程中具有重要作用。

关键词: 分枝杆菌感染, 结核病, 冷脓肿, 肝脏, 脾脏

Abstract:

Systemic disseminated tuberculosis with liver and spleen abscesses as initial symptom is rare. The course of diagnosis and treatment of one case of tuberculosis with liver and spleen abscesses as initial symptom is reported in this paper. Based on the symptoms, signs and findings of pathological and CT examinations after splenectomy, tuberculosis was highly suspected, and diagnostic anti-tuberculosis treatment combined with anti-infection treatment was carried out. The temperature of the patient decreased to the normal range 2 weeks later, which indicated a effective therapy. Then, mycobacterium tuberculosis infection was proven by bacterial culture of puncture fluid and secretions, PCR amplification and nucleotide sequencing. Therefore, in case of highly suspected mycobacterium tuberculosis infection, diagnostic anti-tuberculosis treatment (combined therapy) can be tried out, and imaging examinations may play a role in the auxiliary diagnosis of tuberculosis.

Key words: mycobacterium infection, tuberculosis, cold abscesses, liver, spleen