Fernández de Orueta Lucía, Rodríguez Álvarez Sergio, Núñez Otero Jorge, Gómez Rubio Mariano, Cacho Calvo Juana, Esteban Fernández Javier
Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España.
Med Clin (Barc). 2012 Oct 20;139(10):443-5. doi: 10.1016/j.medcli.2012.04.029. Epub 2012 Jul 17.
To describe an unusual clinical presentation as isolated splenic tuberculosis.
We report a case of isolated splenic tuberculosis, a rare form of extrapulmonary tuberculosis in an immunocompetent patient, and, as a peculiarity, debuts in the form of symptomatic hypercalcemia.
We deeply report the clinical case and the procedures performed to exclude other diseases. We emphasize the usefulness of fine needle aspiration of the spleen to obtain microbiological samples, and the use of specific polymerase chain reaction for mycobacterias to establish the definitive diagnosis of this entity. In agreement with other authors, we chose initial medical treatment with antituberculous drugs, reserving surgery for refractory cases or in case of spontaneous splenic rupture.
Hypercalcemia can be a presentation of granulomatous diseases. The isolated involvement of the spleen by mycobacterias is a rare form of extrapulmonary tuberculosis and more so in immunocompetent patients.
描述孤立性脾结核这一不寻常的临床表现。
我们报告一例孤立性脾结核病例,这是免疫功能正常患者中一种罕见的肺外结核形式,其特殊之处在于以症状性高钙血症的形式初次出现。
我们深入报告该临床病例以及为排除其他疾病所进行的检查。我们强调经皮脾穿刺细针抽吸获取微生物样本的作用,以及使用针对分枝杆菌的特异性聚合酶链反应来确立该疾病的明确诊断。与其他作者观点一致,我们选择先用抗结核药物进行初始治疗,对于难治性病例或出现自发性脾破裂的情况则考虑手术治疗。
高钙血症可能是肉芽肿性疾病的一种表现。分枝杆菌单独累及脾脏是肺外结核的一种罕见形式,在免疫功能正常的患者中更为少见。