Lu C L, Hwang S J, Chang C F, Wu J C, Chiang H, Chiang J H, Lee S D
Department of Medicine, Veterans General Hospital-Tiapei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1993 May;51(5):381-5.
A fatal case of hepatic actinomycosis with portal vein thrombosis is reported. The diagnosis of actinomycosis was delayed because of its rarity in Taiwan. This 63-year-old man was admitted due to body weight loss and poor appetite. No fever was noted before admission. Liver biochemical test showed a decreased serum albumin level with elevated serum levels of globulin and alkaline phosphatase. He was not a hepatitis B carrier and his serum level of alfafetoprotein was within normal range. Image studies (abdominal sonography and computed tomography) showed a hepatic mass over the medial segment of the left lobe with involvement of right lobe of the liver. Main portal vein thrombosis was also seen. Because of profound cachexia, he died of aspiration pneumonia and disseminated intravascular coagulation on the 11th day after admission. An autopsy revealed hepatic actinomycosis. High index of suspicion for early diagnosis and treatment is emphasized.
本文报告一例伴有门静脉血栓形成的肝放线菌病致死病例。由于放线菌病在台湾较为罕见，其诊断被延误。该63岁男性因体重减轻和食欲不佳入院。入院前无发热症状。肝脏生化检查显示血清白蛋白水平降低，球蛋白和碱性磷酸酶水平升高。他并非乙肝携带者，血清甲胎蛋白水平在正常范围内。影像学检查（腹部超声和计算机断层扫描）显示左叶内侧段有一肝脏肿块，累及右叶肝脏。还可见主要门静脉血栓形成。由于极度恶病质，他在入院后第11天死于吸入性肺炎和弥散性血管内凝血。尸检发现肝放线菌病。强调早期诊断和治疗的高度怀疑指数。
