Intractable Hypercalcemia and Massive Ascites in a Hemodialysis Patient with Intraperitoneal Nodules: The Differential Diagnosis and Management

一個血液透析病人的難治性高血鈣症、腹水、及腹腔內結節：鑑別診斷及處置

洪致庭(Chih-Ting Hung) ； 郭弘典(Hung-Tien Kuo) ； 陳鴻鈞(Hung-Chun Chen)

《Acta Nephrologica》 20卷3期 (2006/07) Pp. 211-214

摘要

一個七十二歲的男性血液透析病人被發現有持續高血鈣及腹部腫脹。腹部超音皮波檢查顯示大量腹水，腹腔電腦斷層檢查顯示許多腹腔內腫瘤。系列檢查顯示：胸部X光沒有肺部病變，B型肝炎表面抗體及C型肝炎抗體為陰性，血清副甲狀腺的值相當低。放射線醫師認為有胃部惡腫瘤，但是腫瘤標記都是陰性，也沒有明顯的胃部腫瘤。由於腹水是單胞球為主，沒有型態不正常的細胞，我們使用經驗性的抗結核藥物治療，腹部腫脹跟腹水很快地消失，追蹤的腹部電腦斷層檢查顯示腹水及腹部腫瘤消失。根據對結核菌藥物反應良好，推論偽腹腔內結核。

關鍵字

高血鈣症 ； 結核 ； 腹水 ； 血液透析

並列摘要

A 72-year-old mule patient on hemodialysis therapy was noted with persistent hypercalcemia and progressively developed abdominal distension. The abdominal echo revealed massive ascites, and computed tomographic (CT) scan showed multiple intraabdominal nodules. Abdominal malignancy was highly suspected. Subsequent studies showed that the chest film was free from pulmonary lesions, the hepatitis markers were negative for hepatitis B and C, and the serum intact parathyroid hormone level was low. All tumor markers surveyed were negative and no definite tumor mass was found although gastric malignancy was suspected by radiologist. Owing to the predominant monocytes without atypical cells in ascitic fluid, we started the empirical anti-TB therapeutic trial although no other evidence of TB was found. The abdominal distention and hypercalcemia improved soon. Follow-up abdominal CT scan revealed resolution of ascites and intraperitoneal nodules. Intraperitoneal TB was diagnosed according to the good response to anti-TB agents.

並列關鍵字

Hypercalcemia ； tuberculosis ； ascites ； hemodialysis