Hussain W, Mutimer D, Harrison R, Hubscher S, Neuberger J
Liver Unit, Queen Elizabeth Hospital, Birmingham.
Gut. 1995 May;36(5):792-4. doi: 10.1136/gut.36.5.792.
A 54 year old Asian woman developed fulminant hepatic failure followed by renal failure. Because of a past history of possible tuberculosis, she was given antituberculous drugs. The chest x ray was normal. A transjugular liver biopsy showed caseating necrosis, granulomas, and acid fast bacilli indicative of miliary tuberculosis. Despite full supportive therapy, her condition deteriorated and she died. Postmortem examination showed widespread miliary tuberculosis; culture confirmed the presence of Mycobacterium tuberculosis. Tuberculosis causes fulminant hepatic failure rarely and only three cases have been described. In this, as with the other cases, hyponatraemia and hepatomegaly were features at presentation. This is the first report of treatment being given before death.
一名54岁的亚洲女性出现暴发性肝衰竭，随后发展为肾衰竭。由于既往有疑似结核病病史，她接受了抗结核药物治疗。胸部X光检查正常。经颈静脉肝活检显示干酪样坏死、肉芽肿和抗酸杆菌，提示粟粒性结核病。尽管给予了全面的支持治疗，她的病情仍恶化并死亡。尸检显示广泛的粟粒性结核病；培养证实存在结核分枝杆菌。结核病很少导致暴发性肝衰竭，仅报道过3例。在本病例中，与其他病例一样，低钠血症和肝肿大是就诊时的特征。这是关于在患者死亡前进行治疗的首例报告。
