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Abstract：
Tuberculosis (TB), a Mycobacterium tuberculosis (Mtb) infection, remains a significant global health concern despite a declining incidence. This report highlights a complex case involving a 24-year-old patient from Angola who presented with a constellation of symptoms, including fever, weight loss, and neurological deficits. The patient had been on chronic corticosteroid therapy, a known risk factor for the reactivation of latent TB infection (LTBI). Her clinical course was marked by diagnostic challenges, such as a previous diagnosis of Kikuchi\'s disease and paradoxical progression despite appropriate tuberculostatic chemotherapy. Miliary TB, characterized by widespread dissemination of Mtb from the primary site of infection, can manifest in various extrapulmonary locations. Central nervous system (CNS) involvement, particularly TB meningitis, is the most severe form of TB, associated with significant morbidity and mortality. The diagnosis of miliary and CNS TB can be elusive due to nonspecific clinical presentations and imaging findings. This case underscores the importance of a high index of suspicion, especially in immunocompromised individuals, and the need for comprehensive microbiological analysis, including cerebrospinal fluid (CSF) examination, to confirm CNS involvement. Furthermore, this case illustrates the challenges associated with TB treatment, including the risk of drug toxicity, medication adherence, and the potential for drug resistance. Treatment duration for miliary TB is extended, typically lasting nine months to a year, and may require adaptation based on the patient\'s clinical response and drug penetration into the CNS. Corticosteroids play a critical role as adjuvant therapy, particularly in cases with perilesional edema or paradoxical reactions during treatment. This case underscores the complexity of diagnosing and managing miliary and CNS TB, emphasizing the importance of considering TB as a diagnostic possibility in patients with nonspecific symptoms and risk factors. Early identification, multidisciplinary collaboration, and tailored therapeutic strategies are essential for achieving optimal outcomes in such challenging cases. Additionally, screening for latent TB infection should be a priority for patients requiring immunosuppressive therapy to mitigate the risk of reactivation.
摘要：
结核病(TB),结核分枝杆菌（Mtb）感染，尽管发病率下降，但仍然是一个重要的全球健康问题。这份报告强调了一个复杂的病例，涉及一名来自安哥拉的24岁患者，他出现了一系列症状，包括发烧,减肥,和神经缺陷。病人一直在接受慢性皮质类固醇治疗，潜伏性结核感染（LTBI）再激活的已知危险因素。她的临床课程充满了诊断挑战，如先前诊断为Kikuchi病和矛盾的进展，尽管进行了适当的结核化疗。胆道结核,以Mtb从感染的主要部位广泛传播为特征，可以表现在不同的肺外位置。中枢神经系统（CNS）受累，特别是结核性脑膜炎，是最严重的结核病，与显著的发病率和死亡率相关。由于非特异性的临床表现和影像学发现，对sysible和CNSTB的诊断可能难以捉摸。这起案件凸显了高度怀疑的重要性,尤其是在免疫受损的个体中，以及全面的微生物分析的需要，包括脑脊液（CSF）检查，以确认中枢神经系统受累。此外，这个案例说明了与结核病治疗相关的挑战，包括药物毒性的风险，药物依从性,和潜在的耐药性。粟粒性结核病的治疗持续时间延长，通常持续九个月到一年，并且可能需要根据患者的临床反应和药物向中枢神经系统的渗透进行适应。皮质类固醇在辅助治疗中起着至关重要的作用，特别是在治疗期间有病灶周围水肿或矛盾反应的情况下。该病例强调了诊断和管理恶性和中枢神经系统结核病的复杂性，强调将结核病作为非特异性症状和危险因素患者的诊断可能性的重要性。早期识别,多学科合作，和量身定制的治疗策略对于在这种具有挑战性的情况下实现最佳结果至关重要。此外,对于需要免疫抑制治疗以降低再激活风险的患者,应优先筛查潜伏性结核感染.
