Ohno N, Uozumi K, Ishitsuka K, Takatsuka Y, Nakano S, Utsunomiya A, Hanada S, Arima T
2nd Department of Internal Medicine, Faculty of Medicine Kagoshima University.
Rinsho Ketsueki. 1996 Feb;37(2):139-44.
We report a patient with adult T-cell leukemia (ATL) complicated with intestinal tuberculosis. A 57-year old man was admitted to our hospital because of fever and dyspnea. He was diagnosed as ATL by leukocytosis [leukocyte count 18,200/microliters with 56% of abnormal lymphocytes which express CD4(+) and CD25(+)] and seropositive result of anti-HTLV-1 antibody. Combination chemotherapy for ATL improved his serum LDH level and peripheral lymph nodes, but fever was still persistent. He had an emergency operation because of perforation of the cecum during the chemotherapy. Histological examination of the resected cecum revealed caseous necrosis and numerous mycobacterium, which induced a diagnosis of intestinal tuberculosis. Although there have been several reports on pulmonary tuberculosis in patients with ATL, this is the first report of intestinal tuberculosis in ATL as far as we know. We conclude that if the patients with ATL have persistent fever of unknown origin, we should take account of intestinal tuberculosis as one of differential diagnosis.
我们报告了一例成人T细胞白血病（ATL）合并肠结核的患者。一名57岁男性因发热和呼吸困难入院。通过白细胞增多症（白细胞计数18,200/微升，其中56%为表达CD4(+)和CD25(+)的异常淋巴细胞）及抗HTLV-1抗体血清学阳性结果，他被诊断为ATL。针对ATL的联合化疗改善了他的血清乳酸脱氢酶水平和外周淋巴结情况，但发热仍持续存在。化疗期间，他因盲肠穿孔接受了急诊手术。切除的盲肠组织学检查显示干酪样坏死和大量分枝杆菌，从而确诊为肠结核。尽管已有多篇关于ATL患者合并肺结核的报道，但据我们所知，这是首例关于ATL合并肠结核的报道。我们得出结论，如果ATL患者存在不明原因的持续发热，应将肠结核作为鉴别诊断之一加以考虑。
