結核性脾臟膿瘍－一病例報告

Tuberculous Splenic Abscesses-A Case Report

林錫泉(Shee-Chan Lin) ； 曾建昌(Jiahn-Chang Tzeng) ； 楊國卿(Kuo-Ching Yang) ； 高進祿(Chin-Rou Kao) ； 周孫衍(Sun-Yen Chou) ； 黃暉庭(Fei-Ting Huang) ； 施壽全(Shou-Chuan Shih) ； 林當淳(Dang-Chwen Lin)

《中華民國消化系醫學會雜誌》 2卷2期 (1985/06) Pp. 101-105

https://doi.org/10.6557/GJTa.198506_2(2).0007

摘要

臨床上脾臟瘍是少見的疾病，抗生素大量使用後脾臟膿瘍的發生率更為降低，致原菌也同常見的化膿必細菌轉變成其他較少見的病菌。本文報告一例病人因急性白血病經化學治療後幷發脾臟多發性結核性膿瘍，利用即時性超間波掃描發現脾臟內多發性大小不一圓形低回音病雙，有些病雙合幷有高回音之氣泡。於超音波指引下施行脾臟細針膿瘍抽吸，抽出一些乳白色膿，細菌染色有抗酸桿菌存在。於脾臟切除後病理切片及脾組織細菌培養均顯示結核性膿瘍。手術後病人接受抗結核治療而獲得痊癒。

關鍵字

脾臟膿瘍 ； 結核病

並列摘要

Splenic abscess is an uncommon clinical entity. In untreated case the mortality rate is very high which had been attributed to delayed clinical diagnosis. Multiple splenic abscesses have higher mortality than that of solitary abscess and are usually diagnosed after autopsy. Tuberculosis is a rare causative organism of splenic abscess as compared with other pyogenic organism. Here we report a case of multiple tuberculous splenic abscesses diagnosed by real-time ultrasonography and fine-needle aspiration and confirmed by culture and pathology after splenectomy.
The patient was a 13 years old boy who suffered from acute myelogenous leukemia and had been treated with chemotherapy. Severe leukopenia and persistent high fever lasting for more than one month were noticed after chemotherapy. Real-time abdominal sonography showed hepatosplenomegaly and a small hypoechojc lesion in the spleen which was misdiagnosed. One week later the patient had sudden onset of abdominal pain and presence of ascites. Follow-up abdominal sonography showed multiple hypoechoic lesions associated with posterior acoustic enhancement in the enlarged spleen. Fine-needle aspiration of the splenic lesion under echo-guidance was performed and some yellowish caseous material was aspirated out which showed positive acid-fast stain. After splenectomy, Mycobacterium tuberculosis was isolated from the spleen by culture. The patient recovered gradually after anti-tuberculous therapy.

並列關鍵字

splenic abscess ； tuberculosis