Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
Department of Gynecologic Oncology, Albert Einstein College of Medicine, Bronx, New York, USA.
BMJ Case Rep. 2024 Aug 31;17(8):e261110. doi: 10.1136/bcr-2024-261110.
An immigrant woman in her 60s with a complex medical history and remote occupational exposure to patients with tuberculosis (TB) presented with abdominal pain, early satiety, bloating and weight loss. Physical exam showed abdominal distention and ascites. Diagnostic paracentesis revealed low serum ascites albumin gradient and elevated ascitic lymphocytic count. However, fluid cytology, bacterial and mycobacterial cultures were negative. An interferon-gamma release assay for TB was indeterminate. MRI of the abdomen and pelvis showed a thickened endometrial stripe. Endometrial biopsy demonstrated non-caseating granulomatous endometritis. No organisms were identified on Grocott methenamine silver or acid-fast bacilli special stains. A tissue block from the endometrial biopsy submitted for DNA sequencing was positive for Urine mycobacterial cultures were obtained and the patient was started on isoniazid, rifampin, ethambutol and pyrazinamide, with significant improvement in her symptoms. Urine mycobacterial cultures were eventually positive for pansusceptible MTB.
一位 60 多岁的移民女性，有复杂的病史，曾在遥远的地方接触过结核病（TB）患者，出现腹痛、早饱、腹胀和体重减轻。体格检查显示腹部膨隆和腹水。诊断性腹腔穿刺显示血清腹水白蛋白梯度低和腹水淋巴细胞计数升高。然而，液体细胞学、细菌和分枝杆菌培养均为阴性。结核干扰素释放试验结果不确定。腹部和骨盆的 MRI 显示子宫内膜条纹增厚。子宫内膜活检显示非干酪性肉芽肿性子宫内膜炎。Grocott 六胺银或抗酸杆菌特殊染色均未发现病原体。从子宫内膜活检中提交进行 DNA 测序的组织块显示为阳性，随后患者开始使用异烟肼、利福平、乙胺丁醇和吡嗪酰胺进行治疗，其症状有明显改善。尿液分枝杆菌培养最终呈全敏感 MTB 阳性。
