Mourad F H, McLean A, Farthing M J
Digestive Diseases Research Centre, St. Bartholomew's Hospital Medical College, London, England.
J Clin Gastroenterol. 1995 Apr;20(3):237-40.
A 22-year-old Pakistani man presented with a 1-year history of recurrent attacks of pancreatitis of unknown etiology that had required hospitalization and extensive investigation in Pakistan. He was admitted with abdominal pain, fever, and weight loss. An ultrasound and computed tomographic scan of the abdomen revealed abdominal lymphadenopathy, bulky and inhomogeneous pancreas, and a large fluid collection anterior to the right lobe of the liver. The collection was aspirated but Gram-stain, Ziehl-Neelsen stain for acid-fast bacilli, and DNA analysis by a highly specific polymerase chain reaction-based assay were negative. Because of a strong clinical suspicion of tuberculosis, the patient was started on antituberculous chemotherapy; 4 weeks later the aspirate grew Mycobacterium tuberculosis (hominis). The patient improved rapidly and has remained well after 18 months follow-up. A high index of clinical suspicion and appropriate microbiological investigation is required for the diagnosis of this rare, but potentially curable cause of pancreatitis.
一名22岁的巴基斯坦男子，有1年复发性胰腺炎病史，病因不明，在巴基斯坦曾住院并接受广泛检查。他因腹痛、发热和体重减轻入院。腹部超声和计算机断层扫描显示腹部淋巴结肿大、胰腺肿大且不均匀，肝脏右叶前方有大量液体积聚。对积液进行了抽吸，但革兰氏染色、抗酸杆菌萋-尼氏染色以及基于高特异性聚合酶链反应的检测进行的DNA分析均为阴性。由于临床高度怀疑为结核病，该患者开始接受抗结核化疗；4周后，积液培养出结核分枝杆菌（人型）。患者病情迅速好转，随访18个月后情况良好。对于这种罕见但有可能治愈的胰腺炎病因的诊断，需要高度的临床怀疑指数和适当的微生物学检查。
