Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Gen Intern Med. 2022 Aug;37(10):2568-2572. doi: 10.1007/s11606-022-07619-w. Epub 2022 May 2.
A 23-year-old previously healthy male presented to the hospital with symptoms of heart failure. He was diagnosed with pericarditis and found to have a reduced left ventricular ejection fraction of 25%. He was noted to have mediastinal lymphadenopathy. Pulmonary and abdominal sampling were non-diagnostic for infection, autoimmune disease, or malignancy. A QuantiFERON Gold returned positive. After a thorough travel history and detailed exam, the patient was diagnosed with disseminated tuberculosis after the discovery of a cutaneous gumma that was found to have acid-fast bacilli present on biopsy with Fite's stain. F-FDG PET CT and cardiac MRI were pursued given that pericardial and myocardial biopsy could not be safely performed due to the patient's hemodynamics. F-FDG PET CT and cardiac MRI did not demonstrate any myocardial pathology responsible for the left ventricular ejection fraction. This case highlights that pulmonary involvement is not necessary for disseminated TB, Fite's stain may be used to identify M. tuberculosis, and that cardiac MRI and F-FDG PET CT may be useful to delineate myocardial involvement in high-risk situations.
一位 23 岁既往健康的男性因心力衰竭症状到医院就诊。他被诊断为心包炎，并发现左心室射血分数降低至 25%。他被发现纵隔淋巴结肿大。肺部和腹部采样未发现感染、自身免疫性疾病或恶性肿瘤。QuantiFERON Gold 检测呈阳性。在详细的旅行史和检查后，患者被诊断为播散性结核，因为在活检中发现了皮肤树胶肿，Fite 染色显示有抗酸杆菌。由于患者的血液动力学不稳定，心包和心肌活检无法安全进行，因此进行了 F-FDG PET CT 和心脏 MRI。F-FDG PET CT 和心脏 MRI 均未显示任何导致左心室射血分数降低的心肌病变。本病例强调了肺部受累并非播散性结核所必需，Fite 染色可用于识别结核分枝杆菌，并且在高危情况下，心脏 MRI 和 F-FDG PET CT 可能有助于描绘心肌受累情况。
