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粟粒性肺结核合并抗利尿激素分泌异常综合征、脑结核瘤及结核性脑膜炎 1 例

[A case of miliary tuberculosis complicated with SIADH, brain tuberculoma, and tuberculous meningitis].

作者信息

Takahara Makoto

机构信息

Department of Internal Medicine, National Nishi-Kofu Hospital, 3368, Yamamiya, Kofu-shi, Yamanashi, 400-0075, Japan.

出版信息

Kekkaku. 2002 Feb;77(2):67-72.

Abstract

A 46-year-old man complained fever, headache, and vertigo after he was given steroid for sudden deafness. He was diagnosed as miliary tuberculosis by his chest CT findings. After admission, 4 anti-tuberculous drugs (INH, RFP, SM, and PZA) were prescribed but his laboratory findings showed SIADH, which was difficult to treat, and steroid was readministered. Brain MRI, examined 2 months after admission, showed brain tuberculomas, and examination of cerebrospinal fluid revealed a diagnosis of tuberculous meningitis. Three months later, meningitis deteriorated transiently, however symptoms and findings improved by increasing steroid. Later, miliary tuberculosis and SIADH were cured, however, some tuberculomas grew larger gradually on brain MRI, and spinal MRI showed tuberculomas in the spinal cord. LVFX, high concentration in CSF, was added. At present (2 yrs after beginning the therapy), lesions in the brain and spinal cord improved but remain with the sequelae.

摘要

一名46岁男性在因突发性耳聋接受类固醇治疗后,出现发热、头痛和眩晕症状。根据胸部CT检查结果,他被诊断为粟粒性肺结核。入院后,给予4种抗结核药物(异烟肼、利福平、链霉素和吡嗪酰胺)治疗,但实验室检查结果显示为抗利尿激素分泌异常综合征(SIADH),治疗困难,于是再次使用类固醇。入院2个月后进行的脑部MRI检查显示有脑结核瘤,脑脊液检查确诊为结核性脑膜炎。3个月后,脑膜炎病情短暂恶化,但通过增加类固醇剂量,症状和检查结果有所改善。后来,粟粒性肺结核和SIADH均治愈,然而,脑部MRI显示一些结核瘤逐渐增大,脊髓MRI显示脊髓中有结核瘤。于是加用了在脑脊液中浓度较高的左氧氟沙星(LVFX)。目前(治疗开始2年后),脑和脊髓的病变有所改善,但仍留有后遗症。

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