Evans R H, Evans M, Harrison N K, Price D E, Freedman A R
Department of Medicine & Infectious Diseases, University Hospital of Wales, Cardiff, UK.
J Infect. 1998 Mar;36(2):236-9. doi: 10.1016/s0163-4453(98)80025-x.
A 29-year-old Caucasian woman presented to hospital with a 2-day history of diarrhoea, anorexia and rigors. Investigations showed abnormal liver function tests, hyponatremia, hypoalbuminaemia and lymphopenia. The initial chest radiograph was normal. A bone marrow trephine biopsy showed non-caseating granulomata and she subsequently developed miliary shadowing on the chest radiograph. A transjugular liver biopsy confirmed the presence of acid-alcohol fast bacilli. Despite starting triple therapy for miliary tuberculosis she remained febrile and developed massive hepatosplenomegaly, jaundice and pancytopenia. Standard triple therapy was substituted with ethambutol, streptomycin and oral prednisolone and the patient made a dramatic recovery. The clinical symptoms of miliary tuberculosis are frequently non-specific and the onset of the illness is often insidious. The liver is involved in almost all patients with miliary tuberculosis, but massive hepatosplenomegaly and jaundice are rare. Standard triple-therapy should be discontinued when there is significant liver dysfunction, and corticosteroids should be considered for patients with miliary tuberculosis who fail to respond to conventional therapy.
一名29岁的白人女性因腹泻、厌食和寒战2天入院。检查显示肝功能检查异常、低钠血症、低白蛋白血症和淋巴细胞减少。最初的胸部X光片正常。骨髓穿刺活检显示非干酪样肉芽肿，随后她的胸部X光片出现粟粒状阴影。经颈静脉肝活检证实存在抗酸杆菌。尽管开始了针对粟粒性肺结核的三联疗法，但她仍持续发热，并出现了巨大肝脾肿大、黄疸和全血细胞减少。标准三联疗法被乙胺丁醇、链霉素和口服泼尼松龙替代，患者病情显著好转。粟粒性肺结核的临床症状通常不具特异性，疾病发作往往隐匿。几乎所有粟粒性肺结核患者的肝脏都会受累，但巨大肝脾肿大和黄疸很少见。当出现明显肝功能障碍时，应停用标准三联疗法，对于对传统疗法无反应的粟粒性肺结核患者应考虑使用皮质类固醇。
