Makiyama Akiko, Okuyama Yusuke, Okajima Tatsuya, Fujimoto Sotaro
Third Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Gastroenterol. 2003;38(12):1167-70. doi: 10.1007/s00535-003-1225-5.
We report a case of tuberculous peritonitis in a 24-year-old male patient. On admission, he was complaining of abdominal fullness and fever. Ultrasound tomography and computed tomography (CT) scan of the abdomen showed massive ascites with multiple septa. The most interesting feature of this case was the diffuse and intense uptake of gallium-67 in the abdomen. Though the initial chest X-ray showed only slight bilateral pleural effusion, and cultures from ascites, stool, sputum, and pleural effusion were negative for Mycobacterium tuberculosis, CT scan of the lung showed a small consolidation shadow with contractile change, similar to tuberculosis. A few days after the CT scan of the lung, the sputum was positive for Mycobacterium tuberculosis. Finally we diagnosed active tuberculous peritonitis, and then started antituberculous therapy. In patients with massive ascites and fever of unknown origin, tuberculous peritonitis must be considered. Gallium-67 scintigraphy has been shown to be useful when there is a high index of suspicion of tuberculous peritonitis.
我们报告一例24岁男性结核性腹膜炎患者。入院时，他主诉腹胀和发热。腹部超声断层扫描和计算机断层扫描（CT）显示大量腹水伴多个分隔。该病例最有趣的特征是腹部镓-67弥漫性强烈摄取。尽管最初的胸部X线仅显示轻微双侧胸腔积液，腹水、粪便、痰液和胸腔积液培养均未发现结核分枝杆菌，但肺部CT扫描显示一个小的实变影伴收缩改变，类似结核病。肺部CT扫描几天后，痰液结核分枝杆菌检测呈阳性。最终我们诊断为活动性结核性腹膜炎，随后开始抗结核治疗。对于有大量腹水和不明原因发热的患者，必须考虑结核性腹膜炎。当高度怀疑结核性腹膜炎时，镓-67闪烁扫描已被证明是有用的。
