Alosaimi Fahad D, Alkharboush Feras A, Altuwariqi Maram H
Department of Psychiatry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Int Med Case Rep J. 2014 Jun 20;7:111-5. doi: 10.2147/IMCRJ.S64855. eCollection 2014.
Miliary tuberculosis (TB) is a serious infection with various presentations that can perplex even the most experienced clinicians. To our knowledge, there is a lack of published reports that link psychiatric symptoms directly with miliary TB (either alone or co-occurring with other medical symptoms). Mental health workers may, therefore, not consider, and consequently miss, this important diagnosis. Here we are reporting a case of cyclical anxiety occurring in a 67-year-old patient. For 3 years prior to admission, the patient failed to respond to multiple courses of different antianxiety medications. The patient required hospital admission as he deteriorated and had a reduced level of consciousness. A chest X-ray revealed bilateral nodules and a magnetic resonance imaging scan showed multiple enhancing tuberculous lesions in the cerebral white matter, brain stem, and cerebellum. A diagnosis of miliary TB was finally made. Several characteristics of this case suggest that the diagnosed anxiety disorder was due to miliary TB. However, we cannot exclude the possibility that generalized anxiety disorder preceded the onset of miliary TB or that both diseases were coincidental. The report serves as a reminder that organic causes for psychiatric symptoms always need to be considered, particularly if they follow an atypical pattern or fail to improve with usual psychiatric medications.
粟粒性肺结核是一种严重感染，临床表现多样，即便经验最丰富的临床医生也可能感到困惑。据我们所知，目前尚无已发表的报告将精神症状与粟粒性肺结核直接关联起来（无论是单独出现还是与其他医学症状同时出现）。因此，心理健康工作者可能不会考虑到这一重要诊断，进而导致漏诊。在此，我们报告一例67岁患者出现周期性焦虑的病例。入院前3年，该患者对多种不同的抗焦虑药物疗程均无反应。患者因病情恶化且意识水平下降而需要住院治疗。胸部X线显示双侧结节，磁共振成像扫描显示脑白质、脑干和小脑有多个强化的结核病灶。最终确诊为粟粒性肺结核。该病例的几个特征表明，所诊断的焦虑症是由粟粒性肺结核引起的。然而，我们不能排除广泛性焦虑症先于粟粒性肺结核发病的可能性，或者两种疾病是巧合并存的可能性。该报告提醒我们，对于精神症状，始终需要考虑其器质性病因，尤其是当症状呈现非典型模式或对常规精神科药物治疗无改善时。
