Henderson C E, Turk R, Dobkin J, Comfort C, Divon M Y
Department of Obstetrics and Gynecology, Jack D. Weiler Hospital, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
J Natl Med Assoc. 1993 Sep;85(9):685-7.
Although miliary tuberculosis is uncommon in pregnancy, it is difficult to diagnose when present and is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection. This article reports two antepartum cases of miliary tuberculosis without any of these risk factors. Bronchial washings for Pneumocystis carinii and HIV screening were negative for both patients. Acid-fast bacilli stains of the bronchial washing and ascitic fluid were also negative. Several weeks were required for ascitic fluid and bronchial biopsy Mycobacterium cultures to be positive. In contrast, acid-fast bacilli were seen within 24 hours in multiple sections of the delivered placentas. Confirming the diagnosis of miliary tuberculosis is an arduous process requiring a high index of suspicion. During pregnancy, pathologic examination of tissue obtained by placental biopsy may facilitate making an early diagnosis of extrapulmonary tuberculosis.
虽然粟粒性肺结核在妊娠期并不常见，但一旦出现则难以诊断，且常与静脉药物滥用、恶性肿瘤、酗酒或人类免疫缺陷病毒感染的产妇病史相关。本文报告了两例产前粟粒性肺结核病例，这两名患者均无上述任何危险因素。两名患者的支气管灌洗检查肺孢子菌及HIV筛查均为阴性。支气管灌洗及腹水的抗酸杆菌染色也均为阴性。腹水及支气管活检的分枝杆菌培养数周后才呈阳性。相比之下，在分娩胎盘的多个切片中24小时内就可见抗酸杆菌。确诊粟粒性肺结核是一个艰巨的过程，需要高度的怀疑指数。在妊娠期，经胎盘活检获取组织的病理检查可能有助于早期诊断肺外结核。
