So Edison, Bolger Dennis Thomas
Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
BMJ Case Rep. 2014 Feb 25;2014:bcr2013202591. doi: 10.1136/bcr-2013-202591.
We report an unusual case of miliary tuberculosis in a 77-year-old Filipino man with hypertension, diabetes mellitus, nephrolithiasis status-post left nephrectomy, presenting with 1 month of fever, generalised weakness and weight loss. Laboratory data were significant for anaemia, hypercalcaemia and acute kidney injury. Chest radiograph showed ground glass opacities and interstitial infiltrates. Extensive workup was performed to evaluate fever and hypercalcaemia. Malignancy, hormonal and septic workup were all unremarkable. Tuberculin skin test was negative. Sputum, pleural fluid, bronchoalveolar lavage and cerebrospinal fluid were acid-fast bacilli (AFB) smear negative. Remarkably, urine AFB smear was positive. Caseating granulomas were seen on transbronchial biopsy. Antituberculosis therapy was initiated which lead to defervescence and initial clinical improvement. However, hospital course became complicated by small bowel obstruction and respiratory failure. He subsequently developed pulseless electrical activity and expired. An autopsy confirmed the presence of tuberculosis in multiple organs including his remaining kidney.
我们报告了一例罕见的粟粒性肺结核病例，患者为一名77岁的菲律宾男性，患有高血压、糖尿病、左侧肾切除术后肾结石，出现发热1个月、全身乏力和体重减轻症状。实验室检查结果显示贫血、高钙血症和急性肾损伤。胸部X线片显示磨玻璃影和间质浸润。为评估发热和高钙血症进行了全面检查。恶性肿瘤、激素及感染方面的检查均无异常。结核菌素皮肤试验为阴性。痰、胸水、支气管肺泡灌洗和脑脊液的抗酸杆菌（AFB）涂片均为阴性。值得注意的是，尿液AFB涂片呈阳性。经支气管活检可见干酪样肉芽肿。开始抗结核治疗后体温下降，临床症状初步改善。然而，住院过程中出现了小肠梗阻和呼吸衰竭等并发症。随后患者出现无脉电活动并死亡。尸检证实包括其剩余肾脏在内的多个器官存在结核。
