Rocha João, Maia Catarina, Ferreira Cardoso Henrique, Sousa Estela, Antunes Teresa, Ceia Filipa, Santos Lurdes, Almeida Jorge
Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT.
Oncology, Centro Hospitalar Universitário de São João, Porto, PRT.
Cureus. 2025 Jan 3;17(1):e76862. doi: 10.7759/cureus.76862. eCollection 2025 Jan.
Disseminated tuberculosis (TB) is a life-threatening disease that presents more frequently in immunosuppressed patients. Its diagnosis is challenging, due to nonspecific clinical presentation and variable sensitivity and specificity of microbiological testing. We report the case of a 75-year-old woman without any known immunosuppressive risk factors who presented with constitutional symptoms, ascites and bilateral pleural effusion. Paracentesis revealed lymphocytic ascites with a low serum-ascites albumin gradient. Thoracocentesis showed lymphocytic exudate. Adenosine deaminase levels were high in ascitic and pleural fluids. A thorough work-up excluded neoplastic causes. After 28 days, a positive ascitic fluid cultural test was obtained, with the identification of complex. No other microbiological isolates were obtained. Diagnosis of disseminated TB was made, and antituberculosis treatment was initiated. This case reinforces the need for a high index of suspicion and a structured approach to diagnose disseminated TB, especially in non-high-incidence settings and in patients without any known immunosuppression.
播散性结核病是一种危及生命的疾病，在免疫抑制患者中更为常见。由于其临床表现不具特异性，以及微生物检测的敏感性和特异性各异，其诊断颇具挑战性。我们报告了一例75岁女性病例，该患者无任何已知的免疫抑制风险因素，出现全身症状、腹水和双侧胸腔积液。腹腔穿刺显示淋巴细胞性腹水，血清-腹水白蛋白梯度较低。胸腔穿刺显示淋巴细胞渗出液。腹水和胸腔积液中的腺苷脱氨酶水平较高。全面检查排除了肿瘤病因。28天后，腹水培养检测呈阳性，鉴定出复合体。未获得其他微生物分离株。确诊为播散性结核病，并开始抗结核治疗。该病例强化了对于播散性结核病诊断需保持高度怀疑和采用结构化方法的必要性，尤其是在非高发病率地区以及无任何已知免疫抑制的患者中。
