Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) in a Patient with Tuberculous Pericarditis

結核性心包膜炎併SIADH：病例報告

荘俊斌(Chun-Pin Chuang) ； 羅世慧(Su-Huey Lo) ； 索任(Jen Suo) ； 鍾鈺壎(Yuh-Shiun Jong) ； 駱惠銘(Huey-Ming Lo)

《中華民國急救加護醫學會雜誌》 15卷4期 (2004/12) Pp. 155-160

https://doi.org/10.30018/JECCM.200412.0004

摘要

一位結核性心包膜炎併SIADH的病例報告。84歲病人因發燒及大量心包膜積液住院，病人被發現有血清低滲透壓、低血鈉、低尿酸及尿液高滲透壓現象，符合SIADH之診斷，同時根據超音波指引下心包膜積液穿刺檢查及臨床病史診斷疑似結核性心包膜炎。我們馬上給予病患抗結核藥及類固醇治療，之後病人的心包膜積水消失並且血中鈉濃度漸漸獲得改善，47天後心包液培養證實有結構菌。我們回顧從1960年以來的文獻都沒有結核性心包膜炎併SIADH的報道，在此提出個案請大家注意有心包膜積液合併SIADH或低血鈉時，一定要想到結核性心包膜炎，及時給予治療才能挽救病人的生命。

關鍵字

結核性心包膜炎 ； SIADH ； 低血鈉

並列摘要

We report a case of tuberculous pericarditis which presented with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This 84-year-old man was admitted due to fever and a large amount of which fulfilled the criteria of SIADH. We made a clinical diagnosis of suspicious tuberculous pericarditis based on echo-guided pericardiocentesis and his clinical history. He was immediately given standard antituberculosis drugs and corticosteroid therapy. His pericardial fluid became positive on the 47th day. We reviewed the literature on tuberculosis pericarditis with SIADH since 1960 and found no such previous report. We present this case to remind clinicans that when controlled with pericardial effusion and SIADH or hyponatremia, tuberculous pericarditis should be considered and ant-tuberculosis treatment begun early to save the patient.

並列關鍵字

tuberculous pericarditis ； inappropriate ADH syndrome ； hyponatremia