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題名 | A Rare Case to Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome after Resection of Thymoma=一個造成結核相關免疫重建炎性症後群的罕見原因:胸腺瘤切除 |
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作者 | 黃國恩; 彭萬誠; 陳健文; Huang, Guo-en; Perng, Wann-cherng; Chen, Chien-wen; |
期刊 | 胸腔醫學 |
出版日期 | 20110400 |
卷期 | 26:2 2011.04[民100.04] |
頁次 | 頁85-92 |
分類號 | 415.462 |
語文 | eng |
關鍵詞 | 甲狀腺; CD4淋巴球缺乏; 瀰漫性結核; 免疫重建發炎症候群; Thymoma; CD4 lymphocytopenia; Disseminated tuberculosis; Immune reconstitution inflammatory syndrome; |
中文摘要 | 結核病相關之免疫重建炎性症候群目前已經是一個被廣泛接受的觀念。然而,在HIV陰性病患身上,只有少數的案例被報導過。我們報告一位30歲HIV測試陰性之男性病患,具有胸腺瘤,CD4淋巴球低下併發瀰漫性肺結核。病患接受了抗結核的治療,並且臨床症狀有改善。經過2個月的有效抗結核治療之後,病患接受手術切除胸腺瘤。然而在術後一周之後,病患被發現產生新的淋巴結腫大以及融合之淋巴炎,並形成皮膚瘻管且流出具大量耐酸桿菌之引流液。此時再檢測CD4淋巴球數目,發現已有改善,故確定免疫重建炎性症候群之診斷。此為罕見之非HIV之感染,在切除胸腺瘤後發生結核病相關之免疫重建炎性症候群之病例。臨床醫師需注意任何的治療或處置若造成免疫力快速重建,則可能產生免疫重建炎性症候群。 |
英文摘要 | Tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS) after human immunodeficiency virus (HIV) treatment is currently a well-accepted concept. IRIS also occurs in non-HIV-infected patients. We presented a 30-year-old HIV-negative man with thymoma, CD4 lymphocytopenia and disseminated tuberculosis. He received anti-tuberculous therapy and responded well initially. Resection of the thymoma was performed 2 months after the initiation of anti-tuberculous therapy. Neck lymph nodes enlarged and became confluent 1 week after surgical resection of the thymoma. A cutaneous fistula developed and pus smear disclosed abundant acid-fast bacilli. The CD4 count at that time was higher than at admission, and the clinical course was compatible with tuberculosis-associated IRIS. The neck lymphadenopathy improved gradually with continuous anti-tuberculous therapy and repeated surgical debridement. Tuberculosis-associated IRIS may occur after rapid restoration of the immunodeficiency status. |
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