Richardus Renate A, Jansen Jeroen C, Steens Stefan C A, Arend Sandra M
Department of Infectious Diseases, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Case Rep Med. 2011;2011:675807. doi: 10.1155/2011/675807. Epub 2011 Apr 7.
We report two immigrants with tuberculosis of the skull base and a review of the literature. A Somalian man presented with bilateral otitis media, hearing loss, and facial and abducens palsy. Imaging showed involvement of both mastoid and petrous bones, extending via the skull base to the nasopharynx, suggesting tuberculosis which was confirmed by characteristic histology and positive auramine staining, while Ziehl-Neelsen staining and PCR were negative. A Sudanese man presented with torticollis and deviation of the uvula due to paresis of N. IX and XI. Imaging showed a retropharyngeal abscess and lysis of the clivus. Histology, acid-fast staining, and PCR were negative. Both patients had a positive Quantiferon TB Gold in-tube result and improved rapidly after empiric treatment for tuberculosis. Cultures eventually yielded M. tuberculosis. These unusual cases exemplify the many faces of tuberculosis and the importance to include tuberculosis in the differential diagnosis of unexplained problems.
我们报告了两例颅底结核患者，并对相关文献进行了综述。一名索马里男子出现双侧中耳炎、听力丧失以及面部和展神经麻痹。影像学检查显示双侧乳突和岩骨受累，病变经颅底延伸至鼻咽部，提示为结核，特征性组织学检查及金胺染色阳性证实了这一诊断，而萋尼氏染色和聚合酶链反应（PCR）结果为阴性。一名苏丹男子因IX和XI神经麻痹出现斜颈和悬雍垂偏斜。影像学检查显示咽后脓肿和斜坡骨质溶解。组织学检查、抗酸染色及PCR结果均为阴性。两名患者的全血γ-干扰素释放试验（Quantiferon TB Gold in-tube）结果均为阳性，经验性抗结核治疗后病情迅速改善。最终培养出结核分枝杆菌。这些不寻常的病例体现了结核病的多种表现形式，以及在不明原因问题的鉴别诊断中考虑结核病的重要性。
