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一名具有免疫能力的健康年轻男性出现非特异性症状的播散性结核病:诊断面临的挑战——病例报告

Disseminated tuberculosis in an immunocompetent healthy young male with nonspecific symptoms: challenges toward diagnosis-a case report.

作者信息

Al Maruf Md Abdullah, Munira Sirajam, Holy Mirza Farzana, Islam Md Foyjul

机构信息

Department of Medicine, 250 Beded Sadar Hospital, Moulvibazar, Bangladesh.

Department of Surgical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh.

出版信息

J Med Case Rep. 2025 Apr 29;19(1):195. doi: 10.1186/s13256-025-05252-9.

Abstract

BACKGROUND

Disseminated tuberculosis, characterized by spread of Mycobacterium tuberculosis to multiple noncontiguous sites, is rare in immunocompetent individuals. Diagnosing disseminated tuberculosis is challenging due to its varied and often nonspecific symptoms.

CASE PRESENTATION

We report the case of a 29-year-old Bangladeshi male with no notable past medical history, who presented with prolonged fever, night sweats, cough, weight loss, and altered bowel habits over 6 months. Initial evaluations in Italy and France did not yield a definitive diagnosis. Further investigations in Bangladesh, including sputum smear, fine-needle aspiration cytology of a postauricular lymph node, abdominal ultrasonography, and magnetic resonance imaging of the brain confirmed disseminated tuberculosis. The patient responded excellently to a standard four-drug antitubercular therapy regimen.

CONCLUSIONS

Disseminated tuberculosis should be considered in patients with systemic symptoms, particularly those from regions with a high tuberculosis burden. Early and accurate diagnosis, despite atypical presentations and initial negative findings, is crucial for effective treatment and improved outcomes.

摘要

背景

播散性结核病的特征是结核分枝杆菌扩散至多个不连续部位,在免疫功能正常的个体中较为罕见。由于其症状多样且往往不具特异性,播散性结核病的诊断具有挑战性。

病例介绍

我们报告一例29岁的孟加拉男性病例,该患者既往无显著病史,出现持续发热、盗汗、咳嗽、体重减轻及排便习惯改变达6个月之久。在意大利和法国的初步评估未得出明确诊断。在孟加拉国进行的进一步检查,包括痰涂片、耳后淋巴结细针穿刺细胞学检查、腹部超声检查及脑部磁共振成像,确诊为播散性结核病。该患者对标准四联抗结核治疗方案反应良好。

结论

对于出现全身症状的患者,尤其是来自结核病负担较高地区的患者,应考虑播散性结核病。尽管临床表现不典型且初始检查结果为阴性,但早期准确诊断对于有效治疗及改善预后至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37e8/12039205/92cc12af4608/13256_2025_5252_Fig1_HTML.jpg

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