Feng Yanjun, Niu Yayan, Yan Jinyu, Wu Meiying, Tang Peijun
Department of Tuberculosis, The Fifth People's Hospital of Suzhou The Affiliated Infectious Diseases Hospital of Soochow University Suzhou China.
Clin Case Rep. 2024 Aug 19;12(8):e9286. doi: 10.1002/ccr3.9286. eCollection 2024 Aug.
This article reports a case of mediastinal lymph node tuberculosis with no obvious symptoms and a concealed focus. This patient, a 33-year-old male, suffered from pain behind the sternum after eating. He underwent three gastroscopic examinations and two fine needle punctures guided by ultrasound gastroscopy but was not diagnosed. Chest-enhanced CT revealed a mediastinal mass compressing the adjacent esophagus, suggesting the possibility of enlarged lymph nodes. Furthermore, T cells from patients infected with tuberculosis tested positive. Ultrasound bronchoscopy revealed enlarged lymph nodes in area 7, and then EBUS-TBNA was performed in that region. Only a few scattered lymphocytes and necrotic tissue were found under the biopsy microscope. The EBUS-TBNA biopsy Xpert MTB/RIF showed low positive results, and the EBUS-TBNA puncture fluid Xpert MTB/RIF was positive. Therefore, he was diagnosed with mediastinal lymph node tuberculosis. After antituberculosis treatment with the 2HREZ/10HRE regimen, the patient's pain behind the sternum gradually alleviated, and the enlarged mediastinal lymph nodes gradually narrowed.
本文报道了一例无症状且病灶隐匿的纵隔淋巴结结核病例。该患者为33岁男性，进食后出现胸骨后疼痛。他接受了三次胃镜检查和两次超声胃镜引导下的细针穿刺，但均未确诊。胸部增强CT显示纵隔肿块压迫相邻食管，提示淋巴结肿大的可能性。此外，结核感染患者的T细胞检测呈阳性。超声支气管镜检查发现7区淋巴结肿大，随后在该区域进行了超声支气管镜引导下经支气管针吸活检（EBUS-TBNA）。活检显微镜下仅发现少量散在淋巴细胞和坏死组织。EBUS-TBNA活检Xpert MTB/RIF检测结果呈低阳性，而EBUS-TBNA穿刺液Xpert MTB/RIF检测呈阳性。因此，他被诊断为纵隔淋巴结结核。采用2HREZ/10HRE方案进行抗结核治疗后，患者胸骨后疼痛逐渐缓解，纵隔肿大淋巴结逐渐缩小。
