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Relapse Extrapulmonary Tuberculosis Presented as Panuveitis-A Case Report
以全葡萄膜炎作為表現的肺外結核復發－病例報告
摘要
目的：報告一以前房房水結核菌聚合酶連鎖反應診斷為全葡萄膜炎作為表現的肺外結核復發之案例。方法：病例報告。結果：一位66歲女性病患，一年前接受腦下垂體結核瘤切除手術併術後抗結核菌藥物使用，但因嚴重腸胃道副作用而於使用8個月後提前中斷抗結核菌藥物。病患主訴右眼持續視力模糊至本院眼科求診，眼科檢查顯示右眼前房發炎反應併輕度玻璃體混濁。前房房水結核菌聚合酶連鎖反應偵測出結核分枝桿菌，因此給予病患抗結核菌藥物使用，經治療後病患右眼眼內發炎已消失。結論：肺外結核可以全葡萄膜炎作為復發表現，而眼結核在診斷上的困難可能耽擱診斷，甚而導致視力預後變差。在這案例中，結核菌聚合酶連鎖反應提供了我們有效的診斷工具。因為結核是具有高度傳染力但可治癒的疾病，因此對於不明原因慢性葡萄膜炎的病態，結核感染亦應列入考慮。
關鍵字
無資料並列摘要
Purpose: To report a case of relapse extrapulmonary tuberculosis presenting as panuveitis and detected by aqueous tuberculosis polymerase chain reaction. Method: Case report. Result: A 66-years-old female had a history of pituitary tuberculoma status post resection one year ago. She received anti-tuberculosis treatment postoperatively for 8 months, but discontinued earlier than scheduled due to severe gastrointestinal side effects. She visited our clinic due to persistent blurred vision in the right eye which she had symptoms for 2 months. Ocular examination revealed anterior chamber reaction with vitreous veil. Mycobacterium tuberculosis was detected by aqueous polymerase chain reaction Anti-tuberculosis drugs were given and her ocular inflammation subsided. Conclusions: Extrapulmonary tuberculosis can relapse as panuveitis. The difficulty in the diagnosis of ocular tuberculosis may delay diagnosis. This can lead to worse visual outcome. In this case, tuberculosis polymerase chain reaction provided an effective diagnostic method. Since tuberculosis is a highly infectious but treatable disease, it should be considered in patients with unexplained chronic uveitis.