Department of Medicine, St. James’s Hospital, Dublin, Ireland.
Ir J Med Sci. 2009 Dec;178(4):527-9. doi: 10.1007/s11845-008-0229-9.
We present a case of a young health care professional from the Indian subcontinent, who presented with a low anal fistula and underwent exploration, debridement and fistulotomy twice. The initial working diagnosis was Crohn's disease. However, Mycobacterium tuberculosis, fully sensitive to all first-line drugs was cultured from the specimens sent from the second surgical procedure. On initiation of anti-tubercular therapy the symptoms improved within 5 weeks. The origin of the patient, high index of suspicion for non-infectious reactivation of tuberculosis in migrant health care workers, importance of a proper history taking including previous exposure and diagnostic workup is stressed.
我们报告了一例来自印度次大陆的年轻医疗保健专业人员，他患有低位肛痿，并接受了两次探查、清创和痿管切开术。最初的临床诊断为克罗恩病。然而，从第二次手术标本中培养出了对所有一线药物均敏感的结核分枝杆菌。开始抗结核治疗后，症状在 5 周内得到改善。考虑到患者来自结核病高发地区，对移民医疗保健工作者中非传染性结核再激活的高度怀疑，强调了详细询问病史（包括既往暴露史和诊断性检查）的重要性。
