Farhadian Shelli, Shenoi Sheela V, Villanueva Merceditas S
Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA.
Department of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
BMJ Case Rep. 2014 Jul 9;2014:bcr2014205371. doi: 10.1136/bcr-2014-205371.
We report a case of a 33-year-old previously healthy Haitian immigrant with a 7-month history of abdominal pain, fever and ascites. He had a history of positive tuberculin skin test but never underwent treatment for latent tuberculosis (TB) infection. Initial examination showed abdominal distension. Abdominal CT scan showed mild ascites, abnormal soft tissue in the greater omentum and small bowel mesentery, retroperitoneal adenopathy, peritoneal thickening and dilated loops of small bowel. Paracentesis and thoracentesis were initially non-diagnostic. HIV testing was negative. The differential diagnosis included lymphoma and TB peritonitis. The omental mass was biopsied under ultrasound guidance, and histopathology revealed non-necrotising granulomas. Sputum cultures and omental biopsy cultures subsequently grew Mycobacterium tuberculosis, and a diagnosis was made of pulmonary TB with TB peritonitis. The patient responded well to the initiation of anti-TB treatment.
我们报告一例33岁的海地移民病例，该患者此前身体健康，有7个月的腹痛、发热和腹水病史。他有结核菌素皮肤试验阳性史，但从未接受过潜伏性结核感染的治疗。初始检查显示腹部膨隆。腹部CT扫描显示轻度腹水、大网膜和小肠系膜内软组织异常、腹膜后淋巴结肿大、腹膜增厚以及小肠肠袢扩张。腹腔穿刺和胸腔穿刺最初未明确诊断。HIV检测为阴性。鉴别诊断包括淋巴瘤和结核性腹膜炎。在超声引导下对网膜肿物进行活检，组织病理学显示为非坏死性肉芽肿。痰培养和网膜活检培养随后培养出结核分枝杆菌，诊断为肺结核合并结核性腹膜炎。患者对抗结核治疗的起始反应良好。
