肝脏及淋巴结播散性结核1例并文献复习

Disseminated tuberculosis involving liver and lymph nodes:a case report and review of the literatures

目的了解肝脏及淋巴结播散性结核的临床特征。方法对复旦大学附属华山医院感染科诊断的1例肝脏及淋巴结播散性结核患者的临床表现、实验室及影像学检查结果、治疗及预后进行分析,并回顾2003-2022年PubMed及中文数据库关于肝脏结核及播散性结核的文献报道,筛选并总结分析播散至肝脏和其他部位结核患者的相关临床资料。结果该例患者为老年男性,主要以反复发热、乏力纳差为主要症状,各种抗感染治疗无效,影像学检查示全身多发异常代谢增高灶,最终依赖活检明确诊断,给予抗结核治疗后,病情好转。结合相关文献和该病例,共82例肝结核合并其他部位播散患者,平均年龄39.3岁(1~59岁),多以发热起病,通过影像学检查及病灶脓液培养或活检明确结核感染,抗痨治疗后预后良好。结论肝脏及淋巴结播散结核为少见肺外结核,临床症状并无特异性。确诊依赖影像学及病理活检。早期诊断很重要。该患者确诊后使用合适的抗结核药物治疗,疗效良好。

Objective To understand the clinical features of hepatic and disseminated tuberculosis.Methods This study analyzes the clinical presentations,laboratory and imaging findings,treatment strategies and prognosis of a patient diagnosed with disseminated tuberculosis involving the liver and lymph nodes by the Department of Infectious Diseases at Huashan Hospital,affiliated with Fudan University.A comprehensive review was conducted of literature form Pubmed and Chinese databases soanning the years 2003 to 2022,focusing on.hepatic tuberculosis and disseminated tuberculosis.Reports pertinent to disseminated hepatic tuberculosis were meticulously screened,and relevant clinical data were extracted and evaluated to underscore patterns,outcomes,and insights into this condition.Results Presented is the case of an elderly male suffering from recurrent epidodes of fever,fatigue,and anorexia,with no response to various anti-infective treatments.Comprensive imaging examinations revealed the presence of multiple abnormal metabolic hypertrophy lesions across the body.The diagnosis of disseminated tuberculosis,including hepatic involvemnt,was ultimately confirmed through biopsy.Subsequent anti-tuberculosis treatment resulted in marked clinical improvement.A literature review,complemented by this case,identified 82 similar patients,with an average age of 39.3 years(1-59 years old),predominantly presenting with fever.Diagnosis was generally established via imaging,culture of lesion pus,or biopsy,and the prognosis post anti-tuberculosis treatment was favorable.Conclusion Hepatic tuberculosis represents an uncommon manifestion of extrapulmonary tuberculosis,characterized by non-specific clinical symptoms,complicating its timely diagnosis.The reliance on imaging techniques and pathological biopsies is crucial for accurate identification.Early detection plays a pivotal role in the management of this condiion.In patient with an allergic constitution,like the case in point,the judicious selection of suitable anti-tuberculosis medications is pivotal for treatment efficay and patient recovery.