Ida Norihiko, Yamamoto Keizo, Gonda Hideo, Oishi Takashi, Suganuma Nobukazu, Yamaguchi Ikuo, Kinoshita Keiko, Suzuki Ryujiro
Department of Respiratory Medicine, Toyohashi Municipal Hospital, Aichi, Japan.
Kekkaku. 2007 Dec;82(12):919-23.
A 44-year-old man consulted medical clinic, complaining of cough and sputum. Then he was admitted to our hospital, because of positive acid-fast bacilli in his sputum and positive PCR (polymerase chain reaction) for Mycobacterium tuberculosis. Combined use of isoniazid (INH), rifampicin (RFP), ethambutol (EB) and pyrazinamide (PZA) was started. But 4 days after starting treatment, we had to suspend tuberculosis chemotherapy because of hepatopathy. Since then he started to complain epigastralgia and vomiting. Plain abdominal X-ray and abdominal computed tomography (CT) led to a diagnosis of ileus. Inspite of insertion of ileus tube symptoms of ileus did not improve. Small bowl series showed severe stenosis at ileum end, necessitating jejunectomy. Macroscopic study revealed a ring ulcer and multiple epithelioid cell granuloma with Langhans' giant cells was detected histopathologically. PCR for M. tuberculosis of extracts from ileum was positive. Therefore the patient was diagnosed small intestinal tuberculosis. Treatment was continued by the combination of INH, RFP, EB, and the symptoms markedly improved. There have been no sign of recurrence since the end of the 6-month treatment for tuberculosis.
一名44岁男性到诊所就诊，主诉咳嗽和咳痰。随后因痰中抗酸杆菌阳性及结核分枝杆菌聚合酶链反应（PCR）阳性而入住我院。开始联合使用异烟肼（INH）、利福平（RFP）、乙胺丁醇（EB）和吡嗪酰胺（PZA）。但治疗开始4天后，因肝病不得不暂停抗结核化疗。此后，他开始抱怨上腹部疼痛和呕吐。腹部平片和腹部计算机断层扫描（CT）诊断为肠梗阻。尽管插入了肠梗阻导管，但肠梗阻症状并未改善。小肠造影显示回肠末端严重狭窄，需要进行空肠切除术。宏观检查发现环形溃疡，组织病理学检查发现多个上皮样细胞肉芽肿及朗汉斯巨细胞。回肠提取物结核分枝杆菌PCR检测呈阳性。因此，该患者被诊断为小肠结核。继续使用INH、RFP、EB联合治疗，症状明显改善。自6个月抗结核治疗结束以来，无复发迹象。
