以體重減輕及疲倦來表現結核性心包膜炎之老年病患：病例報告

結核性心包膜炎占肺結核感染比率的1～2%，臨床症狀多以發燒、喘、胸痛來表現，但仍有某些個案以非特異性症狀，例如：體重減輕、疲倦來表現，而增加臨床上延遲診斷或誤判之機率。結核性心包膜炎多發生於中老年病患，產生心包膜積液引發心衰竭甚至心包膜填塞，進一步可能出現限制性心包膜炎，影響患者的預後。在易感染結核病的高風險的族群，若出現心包膜炎的症狀，心臟超音波可用於偵測心包膜積液及確認是否造成心包膜填塞，確認診斷仍須依賴心包膜穿刺或心包膜切開術，以取得微生物染色培養或病理學證據。其他可能有助於診斷的檢查如：心包膜積液分析及其ADA值、痰液染色培養或身體其他部位切片確診為結核菌。本文報告一位確診為結核性心包膜炎之66歲男性患者，藉此討論此少見個案於老年病患之非特異性表現、診斷流程及用藥處置考量。

關鍵字

結核性心包膜炎；肺外結核；限制性心包膜炎；心包膜切開術

並列摘要

Tuberculosis pericarditis reports a prevalence of 1~2% among patients with pulmonary tuberculosis (TB) and occurs mainly in elderly patients. Clinical manifestations may include fever, dyspnea, chest pain or non-specific symptoms like body weight loss or malaise; diagnosis is therefore often difficult or delayed, resulting in late complications such as constrictive pericarditis and increased mortality. Tuberculosis pericarditis needs to be taken into consideration when patients with pericarditis are at high risk for tuberculosis exposure. Echocardiography is a non-invasive tool to detect pericardial effusion and signs of tamponade. Pericardiocentesis is warranted for verifying suspected tuberculosis pericarditis. The diagnosis is established by detection of tubercle bacilli of pericardial fluid or histological examination of the pericardium. We discussed the rare case of a 66-year-old man presenting non-specific symptoms and diagnosed with tuberculosis pericarditis so as to provide reference for the diagnosis, medication, and treatment of tuberculosis pericarditis in the elderly.

並列關鍵字

tuberculosis pericarditis ； extra-pulmonary tuberculosis ； constrictive pericarditis ； pericardiectomy

國際替代計量

以體重減輕及疲倦來表現結核性心包膜炎之老年病患：病例報告

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