结核病：伪装大师。

Tuberculosis: The Master Masquerader.

作者信息

Poornima Abarna, Shetty Adarsha, Baikunje Nandakishore, Belur Giridhar, M T Chandramouli

机构信息

Pulmonary Medicine, K. S. Hegde Medical Academy (KSHEMA), Mangaluru, IND.

出版信息

Cureus. 2025 Mar 7;17(3):e80221. doi: 10.7759/cureus.80221. eCollection 2025 Mar.

DOI:10.7759/cureus.80221

PMID:40196057

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11973533/

Abstract

A 54-year-old male presented with a large, left-sided hemorrhagic exudative pleural effusion characterized by lymphocytic predominance and a low adenosine deaminase (ADA) level. A pleural biopsy was performed via medical thoracoscopy. The results of histopathology and GeneXpert-MTB/RIF (/Rifampicin) (Cepheid, Sunnyvale, California, USA) were inconclusive. PET-CT imaging revealed heightened metabolic activity in the mediastinal lymph nodes, further supported by endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA), showing granulomatous lymphadenitis with caseous necrosis. The patient was diagnosed with tuberculous pleural effusion and showed clinical improvement after initiating anti-tubercular therapy.

摘要

一名54岁男性出现大量左侧出血性渗出性胸腔积液，其特征为淋巴细胞为主且腺苷脱氨酶（ADA）水平低。通过内科胸腔镜进行了胸膜活检。组织病理学和GeneXpert-MTB/RIF（/利福平）（美国加利福尼亚州森尼韦尔市赛沛公司）检测结果不明确。PET-CT成像显示纵隔淋巴结代谢活性增强，支气管内超声（EBUS）和经支气管针吸活检（TBNA）进一步证实，显示为伴有干酪样坏死的肉芽肿性淋巴结炎。该患者被诊断为结核性胸腔积液，开始抗结核治疗后临床症状改善。