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慢性肾脏病腹膜透析患者出现巨大脑结核瘤、波特病和高钙血症。

Massive cerebral tuberculomas, Pott's disease and hypercalcaemia secondary to in a patient with chronic kidney disease on peritoneal dialysis.

机构信息

Department of Nephrology, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico

Department of Nephrology, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico.

出版信息

BMJ Case Rep. 2024 Sep 3;17(9):e261875. doi: 10.1136/bcr-2024-261875.

DOI:10.1136/bcr-2024-261875
PMID:39231571
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11409318/
Abstract

Tuberculosis (TB) is still a health problem in developing countries. Pulmonary involvement remains the most common clinical presentation. However, multiorgan involvement can be life-threatening. We present the case of a young woman on peritoneal dialysis who was admitted to hospitalisation for hypercalcaemia and low back pain. In his biochemical evaluation, suppressed intact parthyroid hormone (iPTH) and elevated 1,25-hydroxyvitamin D were detected. On a lumbar CT scan, a hypodense lesion in vertebral bodies compatible with Pott's disease was found. Positive cultures for were obtained in bronchoalveolar lavage and peritoneal fluid, for which specific treatment was initiated. Due to neurological deterioration, a CT scan was performed showing the presence of multiple tuberculomas. Retrospectively, the lack of an etiological diagnosis of chronic kidney disease, the initiation of dialysis 8 months before and the clear evidence of long-standing TB strongly suggest mycobacterium infection as the cause or trigger for the rapid decline in kidney function.

摘要

结核病(TB)仍然是发展中国家的一个健康问题。肺部受累仍然是最常见的临床表现。然而,多器官受累可能危及生命。我们报告了一例正在接受腹膜透析的年轻女性患者,因高钙血症和腰痛住院。在生化评估中,发现了抑制的完整甲状旁腺激素(iPTH)和升高的 1,25-羟维生素 D。在腰椎 CT 扫描中,发现了与波特氏病相容的椎体低密度病变。支气管肺泡灌洗液和腹腔液中均获得了 的阳性培养,为此启动了特异性治疗。由于神经功能恶化,进行了 CT 扫描,显示存在多个结核瘤。回顾性分析表明,慢性肾脏病的病因诊断缺失、透析开始前 8 个月以及长期结核病的明确证据强烈提示分枝杆菌感染是导致肾功能迅速下降的原因或触发因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68c8/11409318/2812b1138084/bcr-17-9-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68c8/11409318/4cb574c353b8/bcr-17-9-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68c8/11409318/2812b1138084/bcr-17-9-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68c8/11409318/4cb574c353b8/bcr-17-9-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68c8/11409318/2812b1138084/bcr-17-9-g002.jpg

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本文引用的文献

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A rare extrapulmonary manifestation of tuberculosis in a chronic kidney disease patient.一名慢性肾脏病患者出现的罕见的肺外结核表现。
Clin Case Rep. 2023 Aug 28;11(9):e7807. doi: 10.1002/ccr3.7807. eCollection 2023 Sep.
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结核分枝杆菌分子药物耐药检测的临床意义:2023 年 TBnet/RESIST-TB 共识声明。
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