Kacprzak Aneta, Oniszh Karina, Podlasin Regina, Marczak Maria, Cielniak Iwona, Augustynowicz-Kopeć Ewa, Tomkowski Witold, Szturmowicz Monika
1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Institute, Plocka 26, 01-138 Warsaw, Poland.
Radiology Department, National Tuberculosis and Lung Diseases Institute, 01-138 Warsaw, Poland.
Diagnostics (Basel). 2022 Aug 4;12(8):1886. doi: 10.3390/diagnostics12081886.
Tuberculosis (TB) is the leading cause of morbidity, hospitalisations, and mortality in people living with HIV (PLWH). The lower CD4+ T-lymphocyte count in the course of HIV infection, the higher risk of active TB, and the higher odds for atypical clinical and radiologic TB presentation. These HIV-related alterations in TB presentation may cause diagnostic problems in patients not knowing they are infected with HIV. We report on a patient without any background medical conditions, who was referred to a hospital with a 4-month history of chest and feet pains, mild dry cough, fatigue, reduced appetite, and decreasing body weight. Chest X-ray revealed mediastinal lymphadenopathy, bilateral reticulonodular parenchymal opacities, and pleural effusion. A preliminary diagnosis of lymphoma, possibly with a superimposed infection was established. Further differential diagnostic process revealed pulmonary TB in the course of advanced HIV-1 disease, with a CD4+ T-lymphocyte count of 107 cells/mm. The patient completed anti-tuberculous therapy and successfully continues on antiretroviral treatment. This case underlines the importance of screening for HIV in patients with newly diagnosed TB.
结核病（TB）是人类免疫缺陷病毒（HIV）感染者发病、住院和死亡的主要原因。在HIV感染过程中，CD4+T淋巴细胞计数越低，发生活动性结核病的风险越高，出现非典型临床和影像学表现的结核病的几率也越高。这些与HIV相关的结核病表现改变可能会给那些不知道自己感染了HIV的患者带来诊断问题。我们报告了一名无任何基础疾病的患者，该患者因胸痛、足部疼痛、轻度干咳、疲劳、食欲减退和体重减轻4个月而被转诊至医院。胸部X线检查显示纵隔淋巴结肿大、双侧网状结节状实质模糊影和胸腔积液。初步诊断为淋巴瘤，可能合并有叠加感染。进一步的鉴别诊断过程显示该患者处于晚期HIV-1疾病阶段，患有肺结核，CD4+T淋巴细胞计数为107个细胞/mm。该患者完成了抗结核治疗，并成功继续接受抗逆转录病毒治疗。该病例强调了对新诊断结核病患者进行HIV筛查的重要性。
