Reichel C, Theisen A, Rockstroh J K, Müller-Miny H, Spengler U, Sauerbruch T
Department of General Internal Medicine, University of Bonn.
Z Gastroenterol. 1996 Aug;34(8):494-6.
Tuberculous splenic abscesses do virtually not occur in immunocompetent patients. Tuberculous abscesses have been reported only from areas, where the prevalence of both HIV infection and tuberculosis is very high such as Central Africa. In our institution two of seven patients with AIDS and disseminated tuberculosis who were treated during the year 1994 developed tuberculous splenic abscesses. Both patients were resident in Central Europe and had fever and weight loss prior to admission. Multiple hypoechoic lesions up to 1.5 cm in diameter developed in the spleen of both patients on day 11 and 16 after admission, respectively. Initially no symptoms related to the splenic involvement and no leucocytosis were seen in both patients. One patient developed leucocytosis and left sided flank pain caused by a subtotal splenic abscess because the diagnosis and therapy of tuberculosis was delayed. Both patients responded promptly to triple drug antituberculous therapy without surgical intervention. We conclude that also in European patients multiple hypoechoic/hypodense lesions in the spleen of HIV positive patients are highly suggestive of disseminated tuberculosis. Follow-up by ultrasound may help to establish the correct diagnosis and may further prevent unnecessary complications in these patients.
免疫功能正常的患者几乎不会发生结核性脾脓肿。仅在艾滋病病毒感染率和结核病患病率都很高的地区（如中非）报告过结核性脓肿。1994年，我们机构治疗的7例艾滋病合并播散性结核病患者中有2例发生了结核性脾脓肿。这两名患者均居住在中欧，入院前有发热和体重减轻症状。分别在入院后第11天和第16天，两名患者的脾脏均出现了直径达1.5厘米的多个低回声病变。最初，两名患者均未出现与脾脏受累相关的症状，也没有白细胞增多。由于结核病的诊断和治疗延误，一名患者出现白细胞增多和脾脓肿破裂引起的左侧胁腹疼痛。两名患者在未进行手术干预的情况下，对三联抗结核治疗均迅速产生反应。我们得出结论，在欧洲患者中，HIV阳性患者脾脏中的多个低回声/低密度病变也高度提示播散性结核病。超声随访有助于确立正确诊断，并可进一步预防这些患者发生不必要的并发症。
