软组织结核性肉芽肿误诊报告并文献复习

发布时间：2018-03-12 23:23

本文选题：结核　切入点：皮肤　出处：《临床误诊误治》2016年12期 　论文类型：期刊论文

【摘要】：目的探讨软组织结核性肉芽肿的临床特征,减少误诊误治。方法对我院收治的1例软组织结核性肉芽肿的临床资料进行回顾性分析,并复习国内外文献。结果本例因右上肢多关节肿痛伴多发皮下肿物反复发作2年余就诊。查血红细胞沉降率31.0 mm/h,尿酸488.9μmol/L,结核杆菌γ-干扰素释放试验39.6 pg/ml。体表肿物彩色多普勒超声示:右侧手背及腕关节皮下多发囊性及混合性回声区。右腕关节MRI平扫+增强扫描示:右腕关节及掌指骨软组织信号异常。遂行肿物切除,术后病理报告符合结核分枝杆菌感染性病变,确诊为软组织结核性肉芽肿,予抗结核治疗后好转出院。出院后继续抗结核治疗,后因血肌酐明显升高,停用抗结核药。随访5个月,关节肿痛及皮下肿物未复发。结论软组织结核性肉芽肿临床少见,及时行结核杆菌γ-干扰素释放试验和局部组织病理检查,可有效减少误诊误治。
[Abstract]:Objective to investigate the clinical features of tuberculous granuloma of soft tissue and reduce misdiagnosis and mistreatment. Methods A case of soft tissue tuberculous granuloma in our hospital was retrospectively analyzed. Results this case was treated for more than 2 years because of multiple joint swelling and pain in the right upper limb with multiple subcutaneous tumors. The erythrocyte sedimentation rate was 31. 0 mm / h, uric acid was 488.9 渭 mol / L, and Mycobacterium tuberculosis 纬-interferon release test was 39. 6 PG / ml. Color Doppler ultrasound showed multiple cystic and mixed echo areas in the subcutaneous region of the right dorsal hand and wrist. The contrast enhanced MRI scan showed abnormal soft tissue signals of the right wrist and metacarpophalangeal bone. The postoperative pathological report was consistent with Mycobacterium tuberculosis infection and was diagnosed as tuberculous granuloma of soft tissue. After antituberculous treatment, the patient was relieved and discharged. After discharge from hospital, antituberculous treatment was continued, and the serum creatinine level was significantly increased. After 5 months follow-up, joint swelling and pain did not recur. Conclusion tuberculous granuloma of soft tissue is rare in clinic. Timely test of IFN- 纬 release of Mycobacterium tuberculosis and local histopathological examination can effectively reduce misdiagnosis and mistreatment.
【作者单位】：福建医科大学福总临床医学院风湿内分泌科;
【分类号】：R52

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