以消化道穿孔伴肺部巨大空洞起病的结核感染

Tuberculosis presenting as gastrointestinal perforation and large confluent pulmonary cavities:a case report

本文报道1例以急性消化道穿孔起病,伴肺部巨大空洞,最终确诊为多部位结核感染的病例。患者男,23岁,主因“腹泻伴间断咳嗽、咳痰3个月,腹痛1个月,加重1 d”入急诊,CT见腹腔大量游离气体,胸部多发巨大空洞伴结节影,考虑消化道穿孔,行剖腹探查及穿孔肠段切除术。后续痰涂片回报抗酸染色阳性伴结核分枝杆菌复合群基因(Xpert)阳性,小肠病理示多量微脓肿形成,抗酸染色阳性。最终确诊为肺结核、肠结核。

We report an unusual case presented as acute gastrointestinal perforation and large confluent pulmonary cavities.A 23-year-old male was admitted to the emergency department with complaints of abdominal pain for 1 month,which exacerbated for 1 day.He also reported a 3-month history of diarrhea and productive cough.Computed tomography(CT)scan showed multiple large confluent cavities in the lung,along with massive free gas in the abdomen suggesting gastrointestinal perforation.Exploratory laparotomy was performed and affected bowel segment was resected.His sputum examination was positive for both acid-fast staining and Mycobacterium tuberculosis complex gene(Xpert)testing.Pathology of small intestine revealed micro-abscess formation and was positive for acid-fast bacilli.A final diagnosis of pulmonary tuberculosis and intestinal tuberculosis was made.