Duraikannan Paramasivan, Saheer S, Balamugesh T, Christopher D J
Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Lung India. 2017 Mar-Apr;34(2):167-169. doi: 10.4103/0970-2113.201315.
A 33-year-old patient, Known case of chronic kidney disease on maintenance dialysis presented with complaints of low-grade fever and weight loss of 2 months duration. Computed tomography (CT) revealed bilateral mild pleural effusion with significant mediastinal and abdominal adenopathy. CT-guided fine-needle aspiration cytology of abdominal lymph nodes and bone marrow culture was suggestive of tuberculosis. The patient was started on four drug anti-tubercular therapy, post 6 weeks of initiation he developed new onset fever and chest X-ray revealed moderate right pleural effusion. Diagnostic thoracocentesis was suggestive of chylothorax. To the best of our knowledge, this is the first case report of chylothorax due to the paradoxical reaction in the HIV-negative tuberculous patient.
一名33岁的患者，已知患有慢性肾脏病并接受维持性透析，出现持续2个月的低热和体重减轻症状。计算机断层扫描（CT）显示双侧轻度胸腔积液，伴有明显的纵隔和腹部淋巴结肿大。腹部淋巴结的CT引导下细针穿刺细胞学检查及骨髓培养提示为结核病。该患者开始接受四联抗结核治疗，治疗开始6周后出现新发发热，胸部X线显示右侧中度胸腔积液。诊断性胸腔穿刺提示为乳糜胸。据我们所知，这是首例关于HIV阴性结核患者因矛盾反应导致乳糜胸的病例报告。
