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主动脉弓结核性霉菌性动脉瘤:一例强调多学科管理方法的病例报告

Tuberculous mycotic aneurysm of aortic arch: a case report emphasising on multidisciplinary management approach.

作者信息

Velu Dhivya, Ibrahim Farrah, Hassoun Ali

机构信息

Department of Internal Medicine, UAB Huntvsille Regional Medical Campus, Huntsville, Alabama, USA

Department of Internal Medicine, UAB Huntvsille Regional Medical Campus, Huntsville, Alabama, USA.

出版信息

BMJ Case Rep. 2021 Feb 18;14(2):e239309. doi: 10.1136/bcr-2020-239309.

Abstract

Although tuberculosis (TB) is a well-known infection worldwide, the disease involvement in blood vessels, mainly aorta, is quite rare. The objective of this case report is to address the importance of a multidisciplinary approach aiming at successful treatment of tuberculosis, especially when presenting with mycotic aneurysm. We report a case of a 45-year-old woman with the history of sputum positive pulmonary TB, presenting with seizures and eventually found to have developed disseminated infection involving multiple organs, including the aorta. The patient was started on WHO-recommended anti-tubercular treatment but ended up requiring surgical intervention for the aneurysm. Although the main modality of treatment is the use of proper and adequate medical therapy, vascular dissemination in the form of mycotic aneurysm is difficult to be dealt singlehandedly due to their irreversible and multifactorial nature, with infection being the leading cause and their tendency to progress despite the primary infection being treated.

摘要

尽管结核病在全球都是一种广为人知的感染性疾病,但血管受累,主要是主动脉受累的情况相当罕见。本病例报告的目的是强调多学科方法对于成功治疗结核病的重要性,尤其是当出现真菌性动脉瘤时。我们报告一例45岁女性,有痰涂片阳性的肺结核病史,出现癫痫发作,最终发现已发展为包括主动脉在内的多器官播散性感染。患者开始接受世界卫生组织推荐的抗结核治疗,但最终因动脉瘤需要手术干预。尽管主要的治疗方式是使用适当且充分的药物治疗,但真菌性动脉瘤形式的血管播散因其不可逆和多因素的性质,很难单独处理,感染是主要原因,且尽管原发性感染得到治疗,它们仍有进展的倾向。

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