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題名 | Tunneled Hemodialysis Catheter-Related Tuberculous Chest Wall Abscess--A Case Report=血液透析導管相關之胸壁結核性膿瘍--病例報告 |
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作者姓名(中文) | 胡亭宇; 白冠壬; 張宗豪; 陳志榮; 余明治; | 書刊名 | 胸腔醫學 |
卷期 | 26:4 2011.08[民100.08] |
頁次 | 頁225-232 |
分類號 | 415.464 |
關鍵詞 | 血液透析導管; 胸壁; 結核; 末期腎衰竭; Tunneled hemodialysis catheter; Chest wall; Tuberculosis; End-stage renal disease; |
語文 | 英文(English) |
中文摘要 | 慢性腎衰竭的病人有較高危險性得到結核病,此族群的病人也比一般人有更高之肺外結核發生率。胸壁結核更是少見的肺外結核,在洗腎的病人只有少數文獻報告過。我們在此報告一位未曾有結核病紀錄的51歲慢性腎衰竭女性病人因右上腹痛及微燒就醫。檢查時發現頸部及腹腔內淋巴腫大,並有肝內結節,但她拒絕更進一步侵入性檢查。因為尿毒症她接受右鎖骨靜脈血液透析導管置入,並開始長期的血液透析。八個月後,洗腎導管周圍胸壁紅腫化膿且頸部淋巴結更加腫大。經右胸壁膿瘍清創及頸部淋巴結切片後,清創之組織及淋巴結切片標本之病理報告證實為結核菌感染且兩者組織培養均長出結核菌。經六個月標準抗結核病藥物治療後,胸壁膿瘍痊癒,頸部及腹部淋巴結、肝內及肺內結節皆消失。就我們所知,血液透析導管相關的胸壁結核性膿瘍病例報告非常少,在台灣也未曾被報告過。藉此病例經驗,對於洗腎病人有久未癒合或對抗生素治療無反應的病灶,更要提高警覺有胸壁結核的可能性。 |
英文摘要 | Patients with chronic renal failure have an increased risk of tuberculosis, and a higher incidence of extrapulmonary tuberculosis than the general population. Among extrapulmonary tuberculosis cases, chest wall tuberculosis is far less frequently encountered, and reports of dialyzed patients with tuberculosis of the chest wall are even rarer.This case is that of a 51-year-old female patient with chronic renal failure but no history of previous tuberculosis, who presented with right upper quadrant abdominal pain and low grade fever. Bilateral neck and intra-abdominal lymphadenopathy and liver nodules were found on physical examination. However, she refused further invasive studies. She then underwent maintenance hemodialysis through a newly indwelled tunneled catheter in the right subclavian area due to uremia. Eight months later, swelling of the chest wall around the tunneled hemodialysis catheter route with abscess formation was detected, and the bilateral neck lymph nodes were greatly enlarged; abscess debridement of the chest wall and neck lymph nodes biopsy were performed, and caseating granulomas were identified. Later, Mycobacterium tuberculosis grew in the cultures. After a 6-month standard anti-tuberculosis treatment, her chest wall abscess, lymphadenopathy, and liver and pulmonary nodules all resolved.To the best of our knowledge, no case of tunneled hemodialysis catheter-related chest wall tuberculosis has been reported in Taiwan. Physicians should maintain a high degree of suspicion of tuberculous chest wall abscess in dialyzed patients with an unresolved chest wall wound or abscess, despite antibiotics treatment. |
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