Liu S, Chen W, Liu W
Department of Internal Medicine, First Affiliated Hospital, West China University of Medical Sciences, Chengdu 610041.
Zhonghua Jie He He Hu Xi Za Zhi. 1998 Sep;21(9):559-61.
To explore appropriate diagnosis and treatment of tuberculosis of bone marrow.
Clinical and pathologic data of 11 cases with tuberculosis of bone marrow out of 2,410 cases underwent biopsy from 1990 to 1997 were retrospectively analyzed.
High fever, weariness, emaciation and anaemia were found in 11 cases, abdominal distension and abdominal pain in 4, ascites in 3, liver and spleen enlargement in 5. All the cases had no local osteoarticular abnormalities. Negative sputum smear acid-fast staining results were found in 11 cases, abnormal liver function in 9, increased erythrocyte sedimentation rate (30-168 mm/1 h) in 6 detected. Chest radiographs showed hematogenous disseminated pulmonary tuberculosis in 4 cases, no tuberculous lesion in 7. Tuberculous granulomas were found in 11 cases, caseous necrosis in 6, and positive granulomatous tissue acid-fast staining results in 3. Ten out of 11 cases accompanied tuberculous lesions in other parts of body except bone marrow. Eight cases recovered after combined antituberculosis chemotherapy, and other 3 died.
Tuberculosis of bone marrow is the bone marrow involvement of hematogenous disseminated tuberculosis with nonspecific manifestations. Possibility of hematogenous disseminated tuberculosis should be considered in patients with long-term high fever, and in addition to common pulmonary abnormalities, the bone marrow biopsy should also be taken into consideration. Moreover, combined antituberculosis chemotherapy should be given immediately after the diagnosis of the disease.
探讨骨髓结核的合适诊断与治疗方法。
回顾性分析1990年至1997年间2410例行活检的病例中11例骨髓结核的临床及病理资料。
11例患者中出现高热、乏力、消瘦及贫血者，腹胀、腹痛者4例，腹水者3例，肝脾肿大者5例。所有病例均无局部骨关节异常。11例痰涂片抗酸染色结果均为阴性，9例肝功能异常，6例红细胞沉降率升高（30～168mm/1h）。胸部X线片显示4例血行播散型肺结核，7例无结核病变。11例发现结核肉芽肿，6例有干酪样坏死，3例肉芽肿组织抗酸染色阳性。11例中有10例除骨髓外身体其他部位伴有结核病变。11例中8例经联合抗结核化疗后痊愈，另3例死亡。
骨髓结核是血行播散型肺结核的骨髓受累表现，临床表现不具特异性。长期高热患者应考虑血行播散型肺结核的可能，除常规肺部检查外，还应考虑骨髓活检。此外，疾病诊断明确后应立即给予联合抗结核化疗。
