Wong C F, Yew W W, Wong P C, Lee J
Tuberculosis and Chest Unit, Grantham Hospital, Aberdeen, Hong Kong.
Chest. 1998 Aug;114(2):626-9.
A 35-year-old Chinese woman initially presented with histologically and bacteriologically confirmed tuberculous lymphadenitis. She was also found to have thrombocytopenia, elevated serum alkaline phosphatase, and bilateral lung infiltrates. After 15 months of antituberculosis treatment, despite resolution of the cervical lymphadenopathy, she started to experience dyspnea. Chest radiograph appearance, thrombocyte count, and liver biochemistry had all deteriorated as well. Histologic findings from tissues obtained via transbronchial biopsy and open lung biopsy were consistent with sarcoidosis but also showed the presence of mycobacterial DNA by the polymerase chain reaction. She subsequently achieved a very good response clinically, radiographically, hematologically, and biochemically with 1-year of corticosteroid treatment for her sarcoidosis, and she remained relapse-free afterwards. The concomitant presence of tuberculosis and sarcoidosis in this patient together with the presence of mycobacterial DNA in the sarcoid lesion reiterate the possibility that mycobacteria or some of its components may be capable of inducing the immune response and the pathologic changes of sarcoidosis.
一名35岁的中国女性最初被组织学和细菌学确诊为结核性淋巴结炎。她还被发现有血小板减少、血清碱性磷酸酶升高以及双侧肺部浸润。经过15个月的抗结核治疗，尽管颈部淋巴结病有所缓解，但她开始出现呼吸困难。胸部X线表现、血小板计数和肝脏生化指标也都恶化了。经支气管活检和开胸肺活检获得的组织学结果与结节病相符，但聚合酶链反应也显示存在分枝杆菌DNA。随后，她接受了为期1年的皮质类固醇治疗结节病，临床、影像学、血液学和生化方面均取得了非常好的效果，此后一直未复发。该患者同时存在结核病和结节病，且结节病病变中存在分枝杆菌DNA，这再次强调了分枝杆菌或其某些成分可能能够诱导结节病免疫反应和病理变化的可能性。
