Köylü R, Tozkoparan E, Pabuşçu Y, Ciftçi F, Bilgiç H, Seber O
Department of Chest Diseases and Tuberculosis, Gülhane Military Medical Academy, Ankara, Turkey.
Int J Tuberc Lung Dis. 1997 Oct;1(5):474-6.
Although tuberculosis is common and well recognised in many countries, unusual presentations of the disease sometimes raise difficulties in differential diagnosis. We report a young patient who presented with weight loss, shortness of breath and easy fatiguability. Extensive lymphadenopathy involving the cervical, axillary and inguinal regions were found on physical examination. Chest X-ray and computed tomography revealed generalized lymphadenopathy of cervical, mediastinal and para-aortic chains, bilateral pulmonary miliary reticulonodular infiltrates, pleural effusion, hepatomegaly with low density, macronodular hypodense areas in spleen, ascites, peritoneal irregularity and thickening of bowel walls. Mantoux test was negative. Peritoneal fluid was exudative, but pleural fluid was transudative, probably due to mediastinal lymphatic obstruction. The initial clinical diagnosis was malignant lymphoma; however, positive sputum smears for mycobacteria and excisional cervical lymph node biopsy revealing caseating granulomatous lymphadenitis were consistent with tuberculosis. The patient responded well to appropriate therapy with regression of radiological abnormalities.
尽管结核病在许多国家都很常见且广为人知，但该疾病的不寻常表现有时会给鉴别诊断带来困难。我们报告了一名年轻患者，其表现为体重减轻、呼吸急促和易疲劳。体格检查发现广泛的淋巴结病，累及颈部、腋窝和腹股沟区。胸部X线和计算机断层扫描显示颈部、纵隔和主动脉旁链的全身性淋巴结病、双侧肺粟粒状网状结节浸润、胸腔积液、肝脏肿大伴低密度、脾脏内大结节性低密度区、腹水、腹膜不规则和肠壁增厚。结核菌素试验为阴性。腹水为渗出液，但胸腔积液为漏出液，可能是由于纵隔淋巴阻塞所致。最初的临床诊断为恶性淋巴瘤；然而，痰涂片抗酸杆菌阳性以及切除的颈部淋巴结活检显示干酪样肉芽肿性淋巴结炎与结核病相符。患者对适当的治疗反应良好，影像学异常消退。
