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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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/07d743e76ca1/cureus-0017-00000080221-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/cfd1c7ef4a72/cureus-0017-00000080221-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/1b7c69ac1752/cureus-0017-00000080221-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/6f7cb3daa1bc/cureus-0017-00000080221-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/1f3b78838078/cureus-0017-00000080221-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/07d743e76ca1/cureus-0017-00000080221-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/cfd1c7ef4a72/cureus-0017-00000080221-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/1b7c69ac1752/cureus-0017-00000080221-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/6f7cb3daa1bc/cureus-0017-00000080221-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/1f3b78838078/cureus-0017-00000080221-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/900b/11973533/07d743e76ca1/cureus-0017-00000080221-i05.jpg

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本文引用的文献

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Epidemiology and effects of sociodemographic factors on extrapulmonary tuberculosis in Ambala, India.印度安巴拉地区肺外结核的流行病学及社会人口因素的影响。
Indian J Tuberc. 2024 Jul;71(3):242-249. doi: 10.1016/j.ijtb.2023.04.028. Epub 2023 Apr 29.
2
The tuberculous pleural effusion.结核性胸腔积液
Breathe (Sheff). 2023 Dec;19(4):230143. doi: 10.1183/20734735.0143-2023. Epub 2023 Dec 19.
3
Tuberculous Pleurisy Diagnosed From Massive Pleural Effusion in an Older Patient With No History of Tuberculosis.在一名无结核病史的老年患者中，从大量胸腔积液诊断出结核性胸膜炎。
Cureus. 2022 Dec 8;14(12):e32333. doi: 10.7759/cureus.32333. eCollection 2022 Dec.
4
Hemorrhagic pleural effusion in Indonesian male with pulmonary tuberculosis: A rare case.印度尼西亚男性肺结核患者出现出血性胸腔积液：1例罕见病例。
Int J Surg Case Rep. 2022 Feb;91:106800. doi: 10.1016/j.ijscr.2022.106800. Epub 2022 Jan 26.
5
Pleural fluid ADA activity in tuberculous pleurisy can be low in elderly, critically ill patients with multi-organ failure.结核性胸膜炎患者若为老年、危重症合并多器官功能衰竭，其胸液 ADA 活性可较低。
BMC Pulm Med. 2020 Jan 14;20(1):13. doi: 10.1186/s12890-020-1049-6.
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Tuberculous pleural effusion.结核性胸腔积液。
Respirology. 2019 Oct;24(10):962-971. doi: 10.1111/resp.13673. Epub 2019 Aug 16.
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Pleural tuberculosis: A concise clinical review.胸膜结核：简明临床综述
Clin Respir J. 2018 May;12(5):1779-1786. doi: 10.1111/crj.12900.
8
Tuberculous Pleural Effusion.结核性胸腔积液
Turk Thorac J. 2015 Jan;16(1):1-9. doi: 10.5152/ttd.2014.001. Epub 2015 Jan 1.
9
The diagnostic utility of pleural fluid adenosine deaminase for tuberculosis in a low prevalence area.低流行地区胸腔积液腺苷脱氨酶对结核病的诊断效用
Int J Tuberc Lung Dis. 2017 Jun 1;21(6):697-701. doi: 10.5588/ijtld.16.0803.
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Tuberculous pleural effusion.结核性胸腔积液
J Thorac Dis. 2016 Jul;8(7):E486-94. doi: 10.21037/jtd.2016.05.87.