当肺结核出血时：肠结核表现为便血
When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia.
摘要(中文译文)
肠结核是结核病的一种不常见但具有临床意义的表现形式，常表现为非特异性胃肠道症状。尽管回盲部是最常受累的部位，但显性消化道出血是一种不常见的表现，尤其是在可能缺乏典型全身症状的老年患者中。一名老年男性在关岛一家社区医院就诊，表现为在诊断为肺结核并开始使用利福平、异烟肼、吡嗪酰胺和乙胺丁醇治疗一周后出现便血。结肠镜检查显示回肠末端有一个大型半环周溃疡，伴有非出血性可见血管。组织病理学评估显示坏死性肉芽肿性炎症，抗酸杆菌染色证实分枝杆菌感染，从而确立了肠结核的诊断。尽管给予了适当的抗结核治疗，但并发肺部及肠道病变反映了疾病负担的进展和不良预后。鉴于患者极度衰弱及临床状况，患者及其家属选择以舒适为导向的照护。本病例突出了肠结核作为消化道出血的一种不常见病因，并强调了其与克罗恩病等疾病的诊断重叠。它强调了在肉芽肿性回肠病变中进行活检的重要性，以及在来自流行地区或具有相关流行病学危险因素的患者中保持对结核病临床警惕的必要性。
Abstract
Intestinal tuberculosis is an uncommon but clinically significant manifestation of tuberculosis that often presents with nonspecific gastrointestinal symptoms. Although the ileocecal region is most frequently involved, overt gastrointestinal bleeding is an unusual presentation, particularly in elderly patients who may lack classic constitutional symptoms. An elderly man presented to a community hospital in Guam with hematochezia one week after the diagnosis of pulmonary tuberculosis and initiation of rifampin, isoniazid, pyrazinamide, and ethambutol. Colonoscopy revealed a large semi-circumferential ulcer in the terminal ileum with a non-bleeding visible vessel. Histopathologic evaluation demonstrated necrotizing granulomatous inflammation, and acid-fast bacilli staining confirmed mycobacterial infection, establishing the diagnosis of intestinal tuberculosis. Despite appropriate anti-tuberculous therapy, the presence of concurrent pulmonary and intestinal disease reflected an advanced disease burden and poor prognosis. Given advanced frailty and clinical status, the patient and his family elected to pursue comfort-focused care. This case highlights intestinal tuberculosis as an uncommon cause of gastrointestinal bleeding and emphasizes its diagnostic overlap with conditions such as Crohn's disease. It underscores the importance of biopsy in granulomatous ileal disease and the need to maintain clinical suspicion for tuberculosis, particularly in patients from endemic regions or with relevant epidemiologic risk factors.
如何引用
AMA
James M Day. When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia.. Cureus. 2026; doi:10.7759/cureus.106399.
APA
James M Day (2026). When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia.. Cureus. https://doi.org/10.7759/cureus.106399
GB/T 7714
James M Day. When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia.[J]. Cureus, 2026 doi:10.7759/cureus.106399.
在 PubMed增强版 阅读全文
翻译全文 · AI 文献问答 · PDF 原文下载 · 引用导出