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抗结核治疗期间,结核性淋巴结炎相关白塞病中出现的葡萄膜炎。

Uveitis developing in tuberculous lymphadenitis-associated Behçet's disease during anti-tuberculosis therapy.

作者信息

Takahashi Saeko, Otomo Kotaro, Kawakami Yoko, Nakamura Morio

机构信息

Department of Pulmonary Medicine Tokyo Saiseikai Central Hospital Tokyo Japan.

Division of Rheumatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan.

出版信息

Respirol Case Rep. 2020 Jul 10;8(6):e00617. doi: 10.1002/rcr2.617. eCollection 2020 Aug.

Abstract

Behçet's disease (BD) is thought to be elicited by triggers such as tuberculosis (TB) infection in individuals with genetically aberrant immune activity, although the exact pathogenesis remains unknown. Seven cases of BD thought to be triggered by TB have been reported to date. In all cases, Behçet's symptoms improved smoothly after starting TB treatment. We present the first report of uveitis developing two months after starting TB treatment in a 46-year-old woman with tuberculous lymphadenitis presenting with oral and genital ulcers and erythema nodosum-like lesions on diagnosis of TB. The appearance of uveitis was attributed to a paradoxical reaction in TB because of simultaneous relapse of lymphadenopathy and retinal findings on fluorescein angiography. Although rare, physicians should be aware that ocular involvement can occur during anti-TB therapy, most likely with extrapulmonary TB, because ocular involvement may decrease patient quality of life if visual symptoms become irreversible with delayed diagnosis and treatment.

摘要

白塞病(BD)被认为是由免疫活性基因异常的个体中的结核(TB)感染等触发因素引起的,尽管确切的发病机制尚不清楚。迄今为止,已有7例被认为由结核引发的白塞病病例报告。在所有病例中,开始抗结核治疗后,白塞病症状均顺利改善。我们报告了首例在一名46岁患有结核性淋巴结炎的女性中,在开始抗结核治疗两个月后发生葡萄膜炎的病例。该患者在诊断为结核时伴有口腔和生殖器溃疡以及结节性红斑样病变。葡萄膜炎的出现归因于结核中的矛盾反应,这是由于淋巴结病同时复发以及荧光素血管造影显示的视网膜病变。尽管罕见,但医生应意识到在抗结核治疗期间可能会发生眼部受累,最有可能发生在肺外结核患者中,因为如果视觉症状因诊断和治疗延迟而变得不可逆转,眼部受累可能会降低患者的生活质量。

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