血行播散型结核致脾结核1例并文献复习

Splenic tuberculosis caused by hematogenous pulmonary tuberculosis: a case report and literature review

目的了解脾结核的临床特征。方法对1例血行播散型结核伴脾结核患者的临床表现、实验室检查结果、治疗的转归进行分析,并结合相关文献复习脾结核的临床特征。结果该例19岁男性患者以咳嗽、发热、盗汗、体重下降为主要表现,胸腔镜检查提示结核,影像学提示全身多处结核合并脾结核,经抗结核治疗后病情好转。通过文献复习,脾结核临床可分为两类,一类作为血行播散型结核的一部分,另一类为原发性脾结核。原发性脾结核临床表现及体征多不典型,免疫缺陷为危险因素,主要表现为脾肿大、发热、消化系统症状等,少数可发生自发性脾破裂(3/32),32例患者经抗结核和/或脾切除治疗后大部分病情得到痊愈和缓解(28/32)。结论脾结核多隐匿起病,临床症状不典型,确诊依赖脾脏影像学及病理活检,抗结核及选择性脾切除为有效治疗手段,预后大多良好。

Objective To understand the clinical features of splenic tuberculosis.Methods The clinical manifestations,laboratory tests,treatment outcomes of a case of splenic tuberculosis caused by hematogenous pulmonary tuberculosis were analyzed.Related literatures about splenic tuberculosis were also reviewed.Results The patient was a 19-year-old male.Cough,fever,night sweats,and weight loss were the main manifestations.Thoracoscopy revealed tuberculosis and imaging suggested splenic tuberculosis and tuberculosis in multiple body sites.Anti-tuberculosis treatment was effective in improving patient conditions.According to literature review,there are two types of splenic tuberculosis:primary splenic tuberculosis or as part of hematogenous pulmonary tuberculosis.The clinical manifestations of primary splenic tuberculosis are usually atypical.Immune deficiency is a significant risk factor of splenic tuberculosis.The main clinical manifestations of splenic tuberculosis are splenomegaly,fever,digestive system symptoms,and occasionally spontaneous splenic rupture(3/32).Most of the patients with splenic tuberculosis(28/32)were cured or improved by anti-tuberculosis treatment and/or splenectomy.Conclusions The onset of splenic tuberculosis is mostly insidious and clinical symptoms usually atypical.The diagnosis relies on radiographic findings,biopsy and pathological examination.Anti-tuberculosis and selective splenectomy are the effective treatment.The outcome of splenic tuberculosis is good in most patients.