Wolff M J, Bitran J, Northland R G, Levy I L
Department of Medicine, University of Chile School of Medicine, Santiago.
Rev Infect Dis. 1991 May-Jun;13(3):373-5. doi: 10.1093/clinids/13.3.373.
Among 60 patients with AIDS seen at our institution, two had splenic abscesses due to Mycobacterium tuberculosis without pulmonary tuberculosis. In both cases splenic abscess was the first manifestation of AIDS; the patients had prolonged fever and had lost weight and experienced malaise; slight hepatomegaly was noted in both instances and peripheral lymphadenopathy in one. Chest radiography gave normal results in one case and showed hilar lymphadenopathy in the other. Ultrasonographic findings were characteristic: homogeneous hepatomegaly and splenomegaly, with multiple filling defects of variable size. Diagnosis required splenectomy in one case and biopsy of cervical lymph nodes in the other. In both cases Ziehl-Neelsen staining gave positive results; M. tuberculosis grew from a culture of splenic tissue of one patient and from a culture of lymph nodal tissue of the other. There was a rapid response to antituberculous therapy. Splenic tuberculosis seems to be a distinct extrapulmonary entity in patients with AIDS. Ultrasonographic images are useful for diagnosis and follow-up.
在我们机构就诊的60例艾滋病患者中，有2例因结核分枝杆菌感染出现脾脓肿，而无肺结核。在这两例中，脾脓肿均为艾滋病的首发表现；患者均有长期发热、体重减轻和全身不适；两例均有轻度肝肿大，其中一例有外周淋巴结病。胸部X线检查，一例结果正常，另一例显示肺门淋巴结病。超声检查结果具有特征性：肝脏和脾脏均匀肿大，有多个大小不一的充盈缺损。诊断方面，一例需要脾切除术，另一例需要对颈部淋巴结进行活检。两例经萋-尼染色均呈阳性；结核分枝杆菌在一例患者的脾组织培养物和另一例患者的淋巴结组织培养物中生长。抗结核治疗反应迅速。脾结核似乎是艾滋病患者一种独特的肺外病变。超声图像对诊断和随访有用。
