以皮下结核性冷脓肿为首要表现的血行播散性肺结核1例

A patient of hematogenous disseminated pulmonary tuberculosis with the primary manifestation of subcutaneous tuberculous cold abscess

1例因“右肘关节疼痛、皮肤破溃、流脓20 d,伴发热6 d”入院的中年男性患者,入院诊断为右肘关节皮肤软组织感染合并窦道形成,肺部感染,先后予头孢孟多酯钠、美罗培南联合利奈唑胺抗感染治疗,体温峰值无下降。完善胸部CT、支气管镜肺泡灌洗液结核分枝杆菌利福平耐药基因检测及破溃皮肤分泌物抗酸染色检查,明确诊断为血行播散性肺结核并发皮下结核性冷脓肿,经过规律抗结核治疗半年,病情痊愈。现对该病例进行报告,旨在提高临床医师对本病的认识,避免误诊、漏诊。

A middle⁃aged male patient admitted for"right elbow pain,skin rupture and fester for 20 d,and fever for 6 d"was initially diagnosed with soft tissue infection in the right elbow accompanying by sinus tract formation and lung infection.Despite anti⁃infection treatment with cefamandole nafate and meropenem combined with linezolid,there was no decrease in body temperature peak.After inspected by chest CT,bronchoscopic alveolar lavage fluid followed by rifampicin resistant gene detection and antiacid staining examination of broken skin secretions,the patient was clearly diagnosed as hematogenous disseminated pulmonary tuberculosis accompanying by subcuta⁃neous tuberculous cold abscess.The patient recovered through regular anti⁃tuberculosis treatment for half a year.This paper aims to improve clinicians′understanding of this disease to avoid misdiagnosis and miss⁃diagnosis by reporting this case.