Hiseni-Kamberi A, Maier W-D, Junker K, Argirov M
Abteilung für Innere Medizin, Kreiskrankenhaus Osterholz, Am Krankenhaus 4, 27711, Osterholz-Scharmbeck, Deutschland.
Institut für Pathologie am Klinikum Bremen-Mitte, Bremen, Deutschland.
Internist (Berl). 2017 Oct;58(10):1097-1101. doi: 10.1007/s00108-017-0254-8.
A 67-year-old man presented with fever, night sweat and abdominal complaints for about 4 weeks. Ultrasound and a computed tomography scan showed distinct ascites as the main finding, presenting as exsudate with predominating lymphoid cells. Because of long-term immunosuppressive therapy with the tumor necrosis factor (TNF)-α inhibitor golimumab for psoriasis, the suspicion for a possible tuberculous peritonitis arose. This was confirmed with an enzyme-linked immunospot assay, a high level of adenosine deaminase in the ascites and a peritoneum which was studded with multiple whitish nodules, corresponding to granulomas with giant cells. With a standard antituberculous regimen the symptoms were quickly relieved and finally complete restitution was achieved.
一名67岁男性出现发热、盗汗和腹部不适约4周。超声和计算机断层扫描显示,主要发现为明显的腹水,表现为以淋巴细胞为主的渗出液。由于长期使用肿瘤坏死因子(TNF)-α抑制剂戈利木单抗进行免疫抑制治疗以治疗银屑病,怀疑可能患有结核性腹膜炎。酶联免疫斑点试验、腹水中高水平的腺苷脱氨酶以及布满多个白色结节的腹膜(对应含有巨细胞的肉芽肿)证实了这一诊断。采用标准抗结核方案后,症状迅速缓解,最终完全康复。