Lefkovits M, Reusser P
Medizinische Universitätsklinik A, Departement Innere Medizin, Kantonsspital Basel.
Schweiz Med Wochenschr. 1996 Dec 28;126(51-52):2241-3.
A 67-year-old male was hospitalized because of nonspecific symptoms and bilateral pleural effusions. He gave no history of cough, dyspnea or thoracic pain. The blood counts showed moderate anemia and high-grade lymphopenia. The tuberculin test and the anergy-panel were both negative. Testing for HIV was negative. Analysis of pleural fluid showed an exudate with 47% lymphocytes and absence of acid-fast bacilli on Ziehl-Neelsen smear. On histologic examination, the pleural tissue showed no evidence of granuloma. However, cultures for mycobacteria of pleural tissue yielded M. tuberculosis. In this case of pleural tuberculosis, leading symptoms were absent and the tuberculin test was negative in the presence of active tuberculosis. In addition, the cells in the pleural effusion were not predominantly lymphocytic. Patients presenting with unclear effusion should undergo extensive investigations, including a tuberculin test, and anergy panel, pleural fluid cultures, and pleural biopsy with cultures for microorganisms, with the object of establishing or ruling out pleural tuberculosis.
一名67岁男性因非特异性症状和双侧胸腔积液入院。他无咳嗽、呼吸困难或胸痛病史。血常规显示中度贫血和重度淋巴细胞减少。结核菌素试验和无反应原检测均为阴性。HIV检测为阴性。胸腔积液分析显示为渗出液，淋巴细胞占47%，齐-尼氏涂片未发现抗酸杆菌。组织学检查显示胸膜组织无肉芽肿证据。然而，胸膜组织的分枝杆菌培养检出结核分枝杆菌。在这例胸腔结核病例中，尽管存在活动性结核，但主要症状缺如且结核菌素试验阴性。此外，胸腔积液中的细胞并非以淋巴细胞为主。出现不明原因胸腔积液的患者应进行全面检查，包括结核菌素试验、无反应原检测、胸腔积液培养以及胸膜活检并进行微生物培养，目的是明确或排除胸腔结核。
