Yang Qiu-Shi, Wang Nian, Ruan Shu-Song
Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou Province, China.
Medicine (Baltimore). 2025 Sep 5;104(36):e44221. doi: 10.1097/MD.0000000000044221.
We report an extremely rare case in which delayed diagnosis and treatment of Mycobacterium tuberculosis infection primarily involving the subcutaneous tissues of an extremity led to hematogenous dissemination of the infection and subsequent deterioration of the patient.
An 82-year-old man presented to our hospital with a painful mass on the right ankle for over a year, as well as persistent fever and shortness of breath for >14 days. He received piperacillin/tazobactam followed by meropenem, which failed to decrease his peak temperature.
After performing chest computed tomography, acid-fast staining of the abscess specimen, GeneXpert M tuberculosis/rifampin assay, and cerebrospinal fluid tests, the patient was diagnosed with miliary pulmonary tuberculosis and tuberculous meningitis hematogenously transmitted from a primary subcutaneous tuberculous abscess.
Isoniazid, rifampin, levofloxacin, linezolid, and ethambutol were administered through a nasogastric tube to treat the tuberculosis, and 5 mg of dexamethasone was administered to reduce the inflammatory response.
The treatment was halted because of poor compliance, and the patient died of respiratory failure within 1 month of returning home.
We suggest tuberculosis screening or biopsy recommendations for chronic soft tissue swellings in high tuberculosis-burden areas, to avoid missed or delayed diagnosis.
我们报告了一例极其罕见的病例，其中主要累及肢体皮下组织的结核分枝杆菌感染的延迟诊断和治疗导致了感染的血行播散以及患者随后的病情恶化。
一名82岁男性因右踝部疼痛性肿块超过一年，以及持续发热和呼吸急促超过14天前来我院就诊。他接受了哌拉西林/他唑巴坦治疗，随后使用美罗培南，但未能降低其最高体温。
在进行胸部计算机断层扫描、脓肿标本抗酸染色、GeneXpert MTB/利福平检测和脑脊液检查后，患者被诊断为粟粒性肺结核和由原发性皮下结核脓肿血行播散引起的结核性脑膜炎。
通过鼻饲管给予异烟肼、利福平、左氧氟沙星、利奈唑胺和乙胺丁醇治疗结核病，并给予5毫克地塞米松以减轻炎症反应。
由于依从性差，治疗中断，患者在回家后1个月内死于呼吸衰竭。
我们建议在结核病高负担地区对慢性软组织肿胀进行结核病筛查或活检建议，以避免漏诊或延迟诊断。
