Diggikar Pradnya M, Reddy Hansini R, Mundada Mayank, Pancholi Tushar, Faruqi Ahsan A
General Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND.
Cureus. 2024 Feb 4;16(2):e53533. doi: 10.7759/cureus.53533. eCollection 2024 Feb.
This case report delves into the intricate challenges of managing tuberculosis (TB) in a 70-year-old male with decompensated chronic liver disease (DCLD) and a history of endoscopic variceal ligation. The patient, initially presenting with symptoms such as black-colored stools, breathlessness, and weight loss, was diagnosed with right-sided pneumonia alongside DCLD. Despite the administration of standard beta-lactam plus macrolide antibiotics, the patient exhibited no improvement. Subsequent bronchoscopy revealed (MTB), prompting the initiation of first-line anti-tubercular therapy. However, the hepatotoxic response necessitated a switch to a modified regimen with non-hepatotoxic drugs, emphasizing the challenge of managing TB in cirrhotic patients. Effective management of MTB infection involves personalized administration of anti-TB drugs, taking into account the individual's chronic liver disease status. This case underscores the importance of treating tuberculosis in liver cirrhosis patients based on the Child-Turcotte-Pugh score. A tailored and vigilant approach is indispensable for the successful management of MTB infection.
本病例报告深入探讨了一名70岁男性患者的复杂治疗挑战，该患者患有失代偿性慢性肝病（DCLD）且有内镜下静脉曲张结扎病史，同时感染了结核病（TB）。患者最初出现黑便、呼吸急促和体重减轻等症状，被诊断为右侧肺炎合并DCLD。尽管使用了标准的β-内酰胺类加大环内酯类抗生素，患者病情并无改善。随后的支气管镜检查发现了结核分枝杆菌（MTB），于是开始进行一线抗结核治疗。然而，由于肝毒性反应，不得不改用非肝毒性药物的改良方案，这凸显了在肝硬化患者中管理结核病的挑战。有效管理MTB感染需要根据个体的慢性肝病状况个性化给药抗结核药物。本病例强调了根据Child-Turcotte-Pugh评分治疗肝硬化患者结核病的重要性。对于成功管理MTB感染，量身定制且警惕的方法必不可少。
