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| 題 名 | 結核性肋膜積液之一病例報告與文獻回顧=A Case Report of Tuberculous Pleural Effusion and Literature Review |
|---|---|
| 作 者 | 蔡瓊雯; 陳柔岑; 樹金忠; | 書刊名 | 臺灣醫學 |
| 卷 期 | 30:1 2026.01[民115.01] |
| 頁 次 | 頁47-52 |
| 分類號 | 415.462 |
| 關鍵詞 | 結核性肋膜積液; 胸膜活檢; 結核菌培養; Tuberculous pleural effusion; Pleural biopsy; Mycobacterial culture; |
| 語 文 | 中文(Chinese) |
| DOI | 10.6320/FJM.202601_30(1).0006 |
| 英文摘要 | Tuberculosis is a chronic infectious disease. Tuberculous pleural effusion (TPE) is the second most common manifestation of extrapulmonary tuberculosis. However, the current standard diagnosis still relies on mycobacterial culture, which is challenging due to its prolonged turn-around time and limited sensitivity. This report presents a case of a 91-year-old male patient with fever, cough, and right-sided chest pain. Chest imaging revealed right-sided pleural effusion with lung collapse. Two thoracenteses revealed exudative, lymphocyte- predominant pleural effusions. The pleural fluid adenosine deaminase (ADA) levels were moderate (18–29 U/L). Acid-fast staining and mycobacterial cultures of sputum were negative. Acid-fast staining of the pleural fluid was also negative on two occasions, and polymerase chain reaction (PCR) testing for Mycobacterium tuberculosis complex DNA was negative as well. Eventually, M. tuberculosis complex was isolated from pleural fluid culture weeks later, and anti-tuberculosis therapy was initiated on hospital day 17, leading to clinical improvement. According to the literature review, mycobacterial culture is current gold standard of TPE and together with rapid molecular diagnostics of PCR are specific to the diagnosis but suffer from low sensitivity. By contrast, pleural ADA levels and the lymphocyte-to-neutrophil (L/N) ratio can aid in the diagnosis of TPE with high sensitivity although their specificity is limited. While pleural biopsy offers higher sensitivity and specificity, it is invasive and may not be suitable for all patients. Therefore, in cases of unexplained lymphocyte-predominant pleural effusion, TPE should be considered, and currently available diagnostic tools should be appropriately applied to establish or exclude the diagnosis. |
本系統中英文摘要資訊取自各篇刊載內容。