Kuno Yoshihiro, Iyoda Masayuki, Aoshima Yumie, Hosaka Nozomu, Sanada Daisuke, Hirai Yuki, Shibata Takanori, Akizawa Tadao
Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
Intern Med. 2010;49(16):1783-6. doi: 10.2169/internalmedicine.49.3760. Epub 2010 Aug 13.
A hemodialysis patient with tuberculous peritonitis with hypercalcemia and high serum soluble interleukin-2 receptor (sIL-2R) and CA-125 levels is reported. An 82-year-old woman who had been on hemodialysis therapy for 6 years was admitted to our hospital for evaluation and treatment of hypercalcemia. Laboratory examination and radiologic studies revealed markedly increased serum sIL-2R and CA-125 levels and exudative ascites, with high levels of adenosine deaminase (ADA) and CA-125, which was suggestive of malignancy or tuberculosis. She was finally diagnosed as having tuberculous peritonitis based on positivity for Mycobacterium tuberculosis in ascitic fluid. The ascites subsided with normalization of hypercalcemia and a marked decrease in serum sIL-2R and CA-125 levels in response to anti-tuberculosis treatment. This case indicates that serum sIL-2R and CA-125 levels can rise to levels suggestive of malignancy in tuberculous peritonitis, and that they can be used to monitor the response to anti-tuberculosis treatment.
本文报告了1例患有结核性腹膜炎的血液透析患者合并高钙血症,且血清可溶性白细胞介素-2受体(sIL-2R)和CA-125水平升高。一名接受血液透析治疗6年的82岁女性因高钙血症的评估和治疗入住我院。实验室检查和影像学研究显示血清sIL-2R和CA-125水平显著升高,且存在渗出性腹水,腺苷脱氨酶(ADA)和CA-125水平较高,提示可能为恶性肿瘤或结核病。最终根据腹水结核分枝杆菌检测阳性确诊为结核性腹膜炎。抗结核治疗后,腹水消退,高钙血症恢复正常,血清sIL-2R和CA-125水平显著下降。该病例表明,结核性腹膜炎患者血清sIL-2R和CA-125水平可升高至提示恶性肿瘤的水平,且可用于监测抗结核治疗的反应。