肺结核合并空洞和胸腔积液的复杂病程
A Complicated Course of Pulmonary Tuberculosis With Cavitary Findings and Pleural Effusion.
摘要(中文译文)
本报告描述了一例39岁男性患者的病例，该患者近期从厄瓜多尔移民而来，因反复发热、胸膜炎性胸痛及进行性呼吸道症状就诊，最初按社区获得性肺炎治疗。尽管接受了经验性抗生素治疗，患者仍出现临床恶化，表现为左侧胸腔积液迅速积聚，影像学显示空洞性肺病变。胸腔积液分析显示为淋巴细胞为主的渗出性积液，腺苷脱氨酶水平升高，尽管抗酸杆菌涂片和培养反复阴性，仍高度怀疑结核性胸膜炎；鉴于结核性胸膜炎中细菌负荷低且生长缓慢，涂片和培养阴性是其公认的局限性。最终诊断通过电视辅助胸腔镜手术确立，胸膜活检显示干酪样肉芽肿，符合结核病（TB），临床病程进一步因耐甲氧西林金黄色葡萄球菌脓胸而复杂化。患者经手术引流及指南导向的抗结核治疗成功治愈，临床状况改善。本病例凸显了非流行地区肺外结核的诊断挑战，并强调了对来自流行地区的患者保持高度警惕的重要性，即使初始微生物学检测为阴性。
Abstract
This report describes the case of a 39-year-old male who recently immigrated from Ecuador and presented with recurrent fevers, pleuritic chest pain, and progressive respiratory symptoms initially treated as community-acquired pneumonia. Despite empiric antibiotic therapy, the patient experienced clinical deterioration with rapid accumulation of a left-sided pleural effusion and imaging evidence of a cavitary lung lesion. Pleural fluid analysis demonstrated a lymphocyte-predominant exudative effusion with elevated adenosine deaminase levels, raising suspicion for tuberculous pleuritis despite repeatedly negative acid-fast bacilli smears and cultures, a well-recognized limitation in tuberculous pleuritis given the paucibacillary burden and slow growth of . Definitive diagnosis was established via video-assisted thoracoscopic surgery, with pleural biopsy revealing caseating granulomas consistent with tuberculosis (TB), with the clinical course further complicated by methicillin-resistant empyema. The patient was successfully treated with surgical drainage and guideline-directed anti-tuberculous therapy, resulting in clinical improvement. This case underscores the diagnostic challenges of extrapulmonary TB in non-endemic regions and highlights the importance of maintaining a high index of suspicion in patients from endemic areas, even when initial microbiologic testing is negative.
如何引用
AMA
Michael W Krakowski, M Eulalia Brito Vera, Javier López-Royo Díaz de la Peña, Garrett A Perchetti, Ryan Gifford, Roxana Lazarescu. A Complicated Course of Pulmonary Tuberculosis With Cavitary Findings and Pleural Effusion.. Cureus. 2026; doi:10.7759/cureus.106192.
APA
Michael W Krakowski, M Eulalia Brito Vera, Javier López-Royo Díaz de la Peña, Garrett A Perchetti, Ryan Gifford, Roxana Lazarescu (2026). A Complicated Course of Pulmonary Tuberculosis With Cavitary Findings and Pleural Effusion.. Cureus. https://doi.org/10.7759/cureus.106192
GB/T 7714
Michael W Krakowski, M Eulalia Brito Vera, Javier López-Royo Díaz de la Peña, Garrett A Perchetti, Ryan Gifford, Roxana Lazarescu. A Complicated Course of Pulmonary Tuberculosis With Cavitary Findings and Pleural Effusion.[J]. Cureus, 2026 doi:10.7759/cureus.106192.
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