PDF(Pubmed)
Abstract：
The distinction between tuberculosis and sarcoidosis presents sometimes a clinical challenge. Their sequential occurrence in the same patient is uncommon. We present the case of a 42-year-old female with a proven diagnosis of tuberculous lymphadenitis who has developed successively nasal tuberculosis and pulmonary sarcoidosis respectively after 10 and 14 months of antituberculosis treatment. The patient presented with bilateral cervical lymphadenopathy. Tuberculin skin test was negative. Chest radiography was normal. An excision biopsy was taken and histopathological examination established tuberculosis diagnosis. Therapy with antituberculosis drugs was started, and cervical lymphadenopathy showed progressive resolution. Subsequently, nearly 10 months after, the patient developed new cervical lymphadenopathies and nasal obstruction. Tuberculosis of the nasal mucosa was confirmed by biopsy. Antituberclosis bitherapy was enhanced by ofloxacin and ethambutol. Thoracic CT scan showed several nodular elements in both lungs, with bilateral enlarged mediastinal adenopathy. Bronchoalveolar lavage showed a lymphocytic alveolitis with a CD4/CD8 ratio of 5, consistent with the diagnosis of pulmonary sarcoidosis. Corticosteroid treatment, in form of oral prednisolone was introduced, 3 months after sarcoidosis diagnosis have been setteled; because of pulmonary fibrosis noticed on thoracic CT. Systemic corticotherapy was continued for a further period of 3 years, until all the lesions cleared out. The present case emphasizes the possible association between tuberculosis and sarcoidosis.
摘要：
结核病和结节病之间的区别有时会带来临床挑战。他们在同一患者中的顺序发生并不常见。我们介绍了一名42岁的女性，其确诊为结核性淋巴结炎，经过10个月和14个月的抗结核治疗后，分别出现了鼻结核和肺结节病。患者表现为双侧颈部淋巴结肿大。结核菌素皮试阴性。胸部X线检查正常。进行了切除活检，组织病理学检查确定了结核病诊断。开始使用抗结核药物治疗，颈淋巴结肿大表现为进行性消退。随后，近10个月后,患者出现新的颈部淋巴结肿大和鼻塞。活检证实鼻粘膜结核。氧氟沙星和乙胺丁醇增强了抗结核生物疗法。胸部CT扫描显示双肺有几个结节成分,双侧纵隔腺病增大。支气管肺泡灌洗显示淋巴细胞性肺泡炎，CD4/CD8比值为5，与肺结节病的诊断一致。皮质类固醇治疗,以口服泼尼松龙的形式被引入，结节病诊断确定后3个月；由于胸部CT发现肺纤维化。全身皮质治疗持续3年，直到所有的病灶清除.本病例强调了结核病和结节病之间的可能关联。
