Disseminated Tuberculosis of the Brain, Brainstem, Spinal cord, Lung, Kidney and Retina - A Case Report

全身多處散布性結核菌病變 －病例報告

傅進華(Chin-Hua Fu) ； 劉安邦(An-Bang Liu) ； 曹汶龍(Wen-Long Tsao)

《慈濟醫學雜誌》 11卷2期 (1999/06) Pp. 191-196

https://doi.org/10.6440/TZUCMJ.199906.0191

摘要

一位37歲女性，因多日來血尿及左側腰部疼痛入院。入院常規檢查，發現病人患有粟狀性肺結核。住院過程中，病人另有嚴重頭痛及發燒的情況。頭部電腦斷層掃瞄發現在腦部有多發性微膿瘍。從腦脊髓液、痰液及尿液中均培養出M. tuberculosis結核菌種。開始給予抗結核菌治療 (INH, EMB, RIF, PZA)效果並不好；因病人的症狀持續惡化，同時結核菌微膿瘍散布在肺部、大腦、腦幹、頸椎、胸椎、腎臟及視網膜。在增加使用 streptomycin及corticosteroids兩種藥物治療後，病人的症狀逐漸改善。之後，病人接受了一年半的規則治療及追蹤至症狀完全改善。

關鍵字

散布性結核菌 ； 結核菌腦膜炎 ； 抗結核菌治療

並列摘要

A 37 year-old woman was admitted to our hospital due to hematuria and left flank pain for 7 days, and military pulmonary tuberculosis was found on arrival. A severe headache and fever developed during the hospital course. A computed tomographic (CT) scan of the head showed multiple tuberculomas in the brain. Later, Mycobacterium tuberculosis was isolated from the cerebrospinal fluid (CSF), sputum, and urine. After initial anti-tuberculosis therapy (Rifampin 600 mg, Pyrazinamide 1250 mg, Ethambutol 1200 mg, and Isoniazid 300 mg per day), the patient still experienced neurological deterioration. Meanwhile tuberculosis disseminated in the brainstem, cervical and thoracic spinal cord, both of lungs, left kidney and left retina. Her clinical symptoms were improved after streptomycin and corticosteroids were used. She was cured without any neurological deficits after one-and-half-a-year follow-up.

並列關鍵字

disseminated tuberculosis, tuberculous meningitis ； anti-tuberculous therapy