Department of Tropical Medicine and Infectious Diseases, Rostock, Germany.
Department of Oral and Maxillofacial Facial Plastic Surgery, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
Infection. 2018 Jun;46(3):427-430. doi: 10.1007/s15010-017-1112-2. Epub 2018 Jan 12.
A 26-year-old HIV-negative male from Ghana was treated for cervical, intrathoracic and abdominal lymph node tuberculosis (TB) and tuberculous hepatitis. Penetration of the thoracic trachea by a mediastinal lymph node had caused bronchomucosal TB. Sputum culture grew M. africanum, sensitive to all first-line antituberculous drugs. Four weeks after the beginning of directly observed treatment with isoniazid, rifampin, pyrazinamide and ethambutol, the right cervical lymph node increased in size, liquefied and caused a spontaneous fistula. A biopsy of the necrotized lymph node revealed rare acid-fast bacilli with a positive PCR for Mycobacterium tuberculosis complex. After debridement, vacuum-assisted closure therapy was performed for 6 weeks. Five months after the beginning of antituberculous therapy, a second paradoxical reaction occurred, with painful swelling of two contralateral supraclavicular lymph nodes. Extirpation of one node yielded a positive PCR for M. tuberculosis complex; the culture was negative. Antituberculous treatment was continued, and additional treatment with oral prednisolone 20 mg daily for 1 month tapering over 10 weeks was introduced, resulting in a decrease in lymphadenopathy. Antituberculous treatment was continued for a total of 9 months. The outcome was favorable, no further lymphadenopathy occurred over the following 6 months.
一位来自加纳的 26 岁 HIV 阴性男性，患有宫颈、胸内和腹部淋巴结结核（TB）和结核性肝炎。纵隔淋巴结穿透胸气管导致支气管黏膜性 TB。痰培养生长出对所有一线抗结核药物敏感的非洲分枝杆菌。在开始异烟肼、利福平、吡嗪酰胺和乙胺丁醇直接观察治疗的四周后，右侧颈部淋巴结增大、液化并导致自发性瘘管。坏死淋巴结的活检显示罕见的抗酸杆菌，结核分枝杆菌复合群 PCR 阳性。清创后，进行了 6 周的真空辅助封闭治疗。抗结核治疗开始后 5 个月，出现第二次矛盾反应，两个对侧锁骨上淋巴结疼痛肿胀。切除一个淋巴结，PCR 检测结核分枝杆菌复合群阳性；培养为阴性。继续抗结核治疗，并额外口服泼尼松龙 20mg，每日 1 次，持续 1 个月，逐渐减少 10 周，导致淋巴结病减少。抗结核治疗共持续 9 个月。结果良好，随后 6 个月未再发生淋巴结病。
