耐药肺结核合并慢性粒细胞白血病及Gilbert综合征1例

Drug-resistant pulmonary tuberculosis complicated with chronic myeloid leukemia and Gilbert syndrome: a case report

患者男, 28岁, 2008年诊断为"肺结核", 2015年诊断为"耐药肺结核", 间断抗结核治疗至2018年, 病情稳定停药。2019年9月耐药肺结核复发, 治疗期间因肝功能异常等药物不良反应, 调整相关抗结核方案, 病情控制一般, 2020年6月于我院调整并加强抗结核治疗, 期间因反复出现黄疸、持续白细胞升高, 行骨髓穿刺及BCR-ABL融合基因、高胆红素血症易感基因检测, 诊断为慢性粒细胞白血病慢性期和Gilbert综合征, 给予酪氨酸激酶抑制剂及保肝辅助治疗, 现患者耐药肺结核临床治愈停药, 慢性粒细胞白血病控制良好, 伴有轻度黄疸。本文对耐药肺结核合并慢性粒细胞白血病、Gilbert综合征这一罕见病例进行了相关总结, 指导临床提高对该病的认识。

A 28-year-old male patient was diagnosed as"tuberculosis"in 2008 and"drug-resistant tuberculosis"in 2015.Anti-tuberculosis treatment was interrupted until 2018,when the disease was cured.The patient was diagnosed with recurrent drug-resistant tuberculosis in September 2019.Due to the adverse drug reactions such as abnormal liver function,the relevant anti-drug-resistant tuberculosis regimen was adjusted.However,the therapeutic effect was not achieved.In June 2020,the patient began to receive the individualized intensive anti-tuberculosis treatment in our hospital.During this period,the patient developed repeated jaundice and persistent leukocytosis.Therefore,bone marrow puncture,and the BCR-ABL fusion gene and hyperbilirubinemia susceptibility gene detection were performed,and the patients was diagnosed with chronic myeloid leukemia(chronic phase)and Gilbert syndrome.Subsequently,the patient received the treatment of tyrosine kinase inhibitor and adjuvant therapy such as liver protection and jaundice reduction.At present,the patient was clinically cured of drug-resistant pulmonary tuberculosis,and chronic myeloid leukemia was well controlled,with only mild jaundice.This article mainly summarized the related diagnosis and treatment of drug-resistant pulmonary tuberculosis complicated with chronic myeloid leukemia and Gilbert syndrome,in order to improve our understanding of the diagnosis and treatment strategies of the disease.