Halimi C, Bringard N, Boyer N, Vilgrain V, Panis Y, Degott C, Brouland J P, Boudiaf M, Valleur P, Henry-Biabaud E, Valla D
Service d'Hépatologie et de Gastroentérologie, Centre Hospitalier Général, Senlis.
Gastroenterol Clin Biol. 1999 Apr;23(4):513-7.
We report two new cases of hepatic brucelloma in addition to the 22 previously reported cases in the literature. Our analysis of these cases reveals certain characteristics. Hepatic brucelloma is a rare localization that follows previously undetected acute brucellosis. Brucelloma is a result of caseification of a granulomatous reaction induced by persistent Brucella in macrophages. Clinical manifestations can mimic malignant liver tumors or pyogenic, amebic liver abscess. Diagnosis is based on the association of characteristic imaging features (central calcification and peripheral necrotic areas), positive serology and hepatic granulomas. Brucella is rarely isolated in the blood or liver. Awareness of this clinical variant can prevent unnecessary laparotomy. Treatment should begin with rifampicine (900 mg per day) and doxycyclin (200 mg per day) for 3 months. If medical treatment is unsuccessful, percutaneous or surgical drainage should be performed. A cure should be achieved in all cases.
除了文献中先前报道的22例病例外，我们还报告了2例肝布鲁氏菌病新病例。我们对这些病例的分析揭示了某些特征。肝布鲁氏菌病是一种罕见的定位情况，继发于先前未被发现的急性布鲁氏菌病。布鲁氏菌病是巨噬细胞中持续存在的布鲁氏菌诱导的肉芽肿反应发生干酪样变的结果。其临床表现可模仿恶性肝肿瘤或化脓性、阿米巴肝脓肿。诊断基于特征性影像学表现（中央钙化和周边坏死区域）、血清学阳性以及肝肉芽肿。血液或肝脏中很少分离出布鲁氏菌。认识到这种临床变异情况可避免不必要的剖腹手术。治疗应首先使用利福平（每日900毫克）和强力霉素（每日200毫克），持续3个月。如果药物治疗不成功，应进行经皮或手术引流。所有病例均应治愈。
