PDF(Pubmed)
Abstract：
Tuberculosis (TB) remains a significant global health concern, with millions affected worldwide each year. Extrapulmonary TB, particularly involving the digestive tract and central nervous system, poses distinctive difficulties in both diagnosis and treatment. We report a case involving a 15-year-old girl with a history of intestinal TB on anti-tuberculous therapy who presented with symptoms suggestive of meningitis, along with abdominal pain and distension. Our initial suspicion was tuberculous meningitis, considering the underlining abdominal TB, which was later supported by cerebrospinal fluid analysis showing lymphocytic-predominant pleocytosis and positive acid-fast bacilli staining. Concurrently, the patient developed hemodynamic instability and severe abdominal pain, which on repeat X-rays of the abdomen showed air under the diaphragms, prompting surgical exploration and revealing multiple ileal perforations. Histopathological examination confirmed TB as the cause of perforation. This case highlights the diagnostic and therapeutic complexities of concurrent tuberculous meningitis and intestinal TB perforation. Early recognition and interdisciplinary management are crucial for optimal patient outcomes.
摘要：
结核病（TB）仍然是一个重要的全球健康问题，每年全世界都有数百万人受到影响。肺外结核,特别涉及消化道和中枢神经系统，在诊断和治疗方面都存在独特的困难。我们报告了一例15岁的女孩，有肠结核病史，接受抗结核治疗，症状提示脑膜炎，伴随着腹痛和腹胀。我们最初怀疑是结核性脑膜炎,考虑到腹部结核，后来得到脑脊液分析的支持，该分析显示淋巴细胞占优势的细胞增多和抗酸杆菌染色阳性。同时,患者出现血流动力学不稳定和严重腹痛，在腹部的重复X射线上显示出隔膜下的空气，提示手术探查并发现多个回肠穿孔。组织病理学检查证实TB是穿孔的原因。该病例强调了并发结核性脑膜炎和肠结核穿孔的诊断和治疗复杂性。早期识别和跨学科管理对于最佳患者预后至关重要。
