- 期刊
Smear Negative Tuberculosis in an 85-Year-Old Female Presenting with Body Weight Loss: A Case Report
一位85歲女性因體重減輕求診後發現痰液檢查陰性肺結核：個案報告
摘要
一位85歲原本健康獨立的女性，因為一個多月來體重減輕、食慾差、虛弱於民國101年1月28日來診，來診前一日覺得氣促但無發燒。胸部X光顯示兩側肺野彌漫性間質浸潤併實質病變。在疑似肺結核感染的診斷下，留取三套痰液結核菌抗酸性染色及培養，但初步痰液抗酸性染色結果為陰性。病患因發燒及氣促逐漸嚴重以肺炎合併急性呼吸衰竭的診斷於2月1日轉入加護病房接受呼吸器、抗生素、類固醇等治療。病患接受上述治療後好轉於2月13日轉回普通病房繼續治療。2月23日接獲肺結核細菌培養陽性報告即給予抗結核藥物，但用藥數天後因出現肝功能異常而停藥。老年人罹患肺結核時比較不會有發燒、夜汗、咳血等典型症狀，在痰液檢查陰性病患早期診斷出肺結核更加困難。老年人接受肺結核治療較易出現副作用，臨床醫師需在依經驗決定治療或等待結核菌培養報告中作出困難的抉擇。
並列摘要
This 85-year-old female had been independent and healthy came to our geriatric clinic on Jan. 28, 2012, due to body weight loss, poor appetite, dysphagia and general weakness during the past one to two months. Mild dyspnea without fever and sputum developed just a day before visiting the clinic. Chest X-ray revealed diffuse interstitial infiltrations with areas of consolidation in the lobes of both lungs. With an initial clinical suspicion of tuberculosis (TB), three sets of sputum acid-fast stains were done, but with negative results, the sputum TB culture results were still pending. Progressive dyspnea and fever developed on Feb. 1, and the patient was admitted to the intensive care unit due to bilateral pneumonia complicated with acute respiratory failure. Ceftriaxone and solucortef were given with ventilator support. Her condition improved after supportive treatment and she was transferred to the general ward on Feb. 13. The positive TB culture results were announced on Feb 23, and anti-TB regimen with ethambutal, isoniazid, and rifamycin was given. Abnormal liver function unfortunately developed days after initiation treatment. Elderly persons are less likely to have classic symptoms of TB, such as fever, night sweats, and hemoptysis than the young. Early identification of TB in patients with a negative sputum smear is even more difficult. This case highlights the need for a high index of suspicion of TB in elders with atypical presentations such as unintentional body weight loss.