Lee Chun-Yuan, Tsai Hung-Chin, Lee Susan Shin-Jung, Sy ChengLen, Chen Yao-Shen
Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Microbiol Immunol Infect. 2016 Aug;49(4):608-12. doi: 10.1016/j.jmii.2013.12.008. Epub 2014 Feb 13.
We report the case of an 81-year-old man diagnosed with liver cirrhosis complicated by spontaneous bacterial peritonitis and septic shock. Mycobacterium tuberculosis complex was isolated from the ascites, sputum, and blood culture 1 month after the patient died. Clinicians should be aware of the unusual diagnosis of sepsis tuberculosa gravissima presenting with tuberculous peritonitis, which is easily misdiagnosed as spontaneous bacterial peritonitis and Gram-negative bacillus sepsis in patients with cirrhosis. Clinicians should cautiously evaluate the patient's sputum, gastric contents, urine, cerebrospinal fluid, and bone marrow for early diagnosis of disseminated tuberculosis in patients with a high degree of suspicion of this diagnosis.
我们报告了一例81岁男性患者，诊断为肝硬化并发自发性细菌性腹膜炎和感染性休克。患者死亡1个月后，从腹水、痰液和血培养中分离出结核分枝杆菌复合群。临床医生应注意重症结核性败血症这一不寻常的诊断，其表现为结核性腹膜炎，在肝硬化患者中很容易被误诊为自发性细菌性腹膜炎和革兰氏阴性杆菌败血症。对于高度怀疑该诊断的患者，临床医生应谨慎评估其痰液、胃内容物、尿液、脑脊液和骨髓，以便早期诊断播散性结核病。
