沙利度胺辅助治疗血行播散性结核病伴发矛盾反应1例

A case of hematogenous disseminated tuberculosis in a patient with contradictory reactions treated with thalidomide

本研究报道了1例接受英夫利西单抗治疗克罗恩病继发活动性结核病患者。患者男,52岁,因发热伴头痛1个月余入院。既往有克罗恩病史13年,入院前曾使用英夫利西单抗2次。通过腰椎穿刺术、支气管镜在脑脊液、灌洗液中发现结核分枝杆菌DNA阳性,诊断结核性脑膜炎、肺结核、支气管结核、淋巴结结核。给予规律抗结核、激素等治疗,治疗期间反复发热、病灶进展、气管腔内多发肉芽形成,考虑合并矛盾反应,予沙利度胺联合糖皮质激素治疗。经1 HREZLfxLzd/8 HEZCsLzd/1 HEZCs/8 HZCs 18个月治疗后,患者临床状况显著改善,胸部CT及气管镜下表现均提示病灶明显吸收,脑脊液、灌洗液病原学阴性,予停药观察。

Here we reported a case of a 52-year-old male with a 13-year history of Crohn′s disease who developed disseminated tuberculosis after 2 injections of infliximab.The patient was admitted with a chief complaint of fever with headache of 1 month′s duration.Mycobacterium tuberculosis DNA was found positive in cerebrospinal fluid and lavage fluid by lumbar puncture and bronchoscopy.He was diagnosed with tuberculous meningitis,pulmonary tuberculosis,tracheobronchial tuberculosis and lymph node tuberculosis.After treatment with anti-tuberculosis and glucocorticoids,the symptoms did not improve,the lesions progressed,and granulomas were formed in the tracheobronchial lumen.These were considered to be contradictory reactions and thalidomide was given together with glucocorticoids.The patient′s clinical condition has improved significantly.Treatment was successfully completed after 18 months with 1 HREZLfxLzd/8 HEZCsLzd/1 HEZCs/8 HZCs.