Yang C W, Lee J H, Kim Y G, Kim Y O, Lee S H, Kim B K, Bang B K
Department of Internal Medicine, Kangnam St. Mary's Hospital, Catholic University Medical College, Seoul, Korea.
Nephron. 1996;72(4):690-2. doi: 10.1159/000188963.
We present an unusual hematologic manifestation of tuberculosis in a hemodialysis patient. A 37-year-old man was admitted because of fever, anorexia, and weight loss which developed 3 months earlier. He previously received a renal transplant and commenced hemodialysis 1 year ago. Physical examination revealed hepatomegaly, and peripheral blood counts revealed pancytopenia. The delayed bone marrow biopsy demonstrated marked hemophagocytosis, granuloma and tubercle bacilli by the acid-fast stain. The clinical course was fatal and he died without definite treatment. Through this case, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, anorexia, weight loss, hepatomegaly and pancytopenia develop in patients undergoing dialysis.
我们报告了一例血液透析患者出现的不寻常的结核病血液学表现。一名37岁男性因3个月前出现发热、厌食和体重减轻入院。他此前接受了肾移植，1年前开始进行血液透析。体格检查发现肝脏肿大，外周血细胞计数显示全血细胞减少。延迟进行的骨髓活检显示有明显的噬血细胞现象、肉芽肿，抗酸染色发现结核杆菌。临床病程是致命的，他未经明确治疗便死亡。通过这个病例，我们建议，如果透析患者出现不明原因发热、厌食、体重减轻、肝脏肿大和全血细胞减少，应尽早进行骨髓活检并给予抗结核治疗。
