Miyakoda Ko, Ono Ryohei, Kitagawa Izumi
Department of General Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa, JPN.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, JPN.
Cureus. 2024 Nov 15;16(11):e73750. doi: 10.7759/cureus.73750. eCollection 2024 Nov.
Tuberculosis (TB) is an infectious disease caused by (MTB). Disseminated TB can cause various types of complications. Extrapulmonary TB includes TB meningitis, abdominal TB, skeletal TB, Pott's disease (spine), scrofula, and genitourinary TB. In particular, TB meningitis is a lethal complication of TB with a high mortality rate. The patient was an 84-year-old Japanese man with a history of tuberculous pleurisy during childhood who presented with fever and altered mental status. Eight months prior, the patient was diagnosed with a urinary tract infection and treated with levofloxacin, but further investigation showed spondylitis. Although the causative microorganism was not identified as levofloxacin likely masked it, he was treated with linezolid and rifampicin for six weeks for the empiric diagnosis of bacterial pyogenic spondylitis; both medications are also antituberculous agents. At this visit, abdominal computed tomography (CT) revealed a left psoas abscess with calcification, and cerebral magnetic resonance imaging revealed multiple nodules with target signs. Cerebrospinal fluid (CSF) findings were consistent with TB meningitis, though the TB polymerase chain reaction, culture, and CSF cytology were all negative. He underwent CT-guided percutaneous drainage for the psoas abscess, and MTB was finally identified. Although he was treated with antituberculous agents including rifampicin, ethambutol, and isoniazid, the patient died seven months after admission as a result of the debilitating effects of tuberculous meningitis. In our case, we should have tried to identify the causative organism in the diagnosis of pyogenic spondylitis. Especially in patients with a history of TB, the possibility of TB should always be considered. In addition, the use of antituberculous drugs may mask the presentation; therefore, biopsy or CT-guided drainage, as used in this case, should be considered for diagnostic accuracy.
结核病（TB）是由结核分枝杆菌（MTB）引起的一种传染病。播散性结核病可导致各种类型的并发症。肺外结核包括结核性脑膜炎、腹部结核、骨骼结核、波特氏病（脊柱结核）、瘰疬和泌尿生殖系统结核。特别是，结核性脑膜炎是结核病的一种致命并发症，死亡率很高。该患者是一名84岁的日本男性，儿童时期有结核性胸膜炎病史，此次因发热和精神状态改变就诊。八个月前，该患者被诊断为尿路感染并接受左氧氟沙星治疗，但进一步检查显示患有脊柱炎。尽管致病微生物未被确定为左氧氟沙星可能掩盖了它，但他因疑似细菌性化脓性脊柱炎而接受了六周的利奈唑胺和利福平治疗；这两种药物也是抗结核药物。在此次就诊时，腹部计算机断层扫描（CT）显示左腰大肌脓肿伴钙化，脑部磁共振成像显示多个有靶征的结节。脑脊液（CSF）检查结果与结核性脑膜炎相符，尽管结核聚合酶链反应、培养和脑脊液细胞学检查均为阴性。他接受了CT引导下经皮穿刺引流治疗腰大肌脓肿，最终确诊为结核分枝杆菌感染。尽管他接受了包括利福平、乙胺丁醇和异烟肼在内的抗结核药物治疗，但患者在入院七个月后因结核性脑膜炎的衰弱影响而死亡。在我们的病例中，我们应该在诊断化脓性脊柱炎时努力确定致病微生物。特别是有结核病史的患者，应始终考虑结核病的可能性。此外，使用抗结核药物可能会掩盖病情表现；因此，为了提高诊断准确性，应考虑像本病例中那样进行活检或CT引导下引流。
