播散性结核病是一种罕见但具有破坏性的结核病,可能随着患者的免疫反应而发展。COVID-19感染可能产生免疫抑制作用,可能与结核病传播有关。
一名17岁女性患者,有结核性胸膜炎病史,因感染COVID-19感染后出现高烧和危及生命的呼吸困难。她的病情迅速恶化,伴有癫痫大发作和急性消化道出血,CD4T细胞计数严重下降,这表明她处于严重的免疫抑制状态。在她的脑脊液中发现结核分枝杆菌和左下背部皮下脓肿后,她被诊断患有累及双肺的播散性结核病,中枢神经系统,回肠末端,肝脏,双侧附件组织,和皮下软组织根据胸部和腹部CT。经验性治疗开始用地塞米松(5毫克/天)和异烟肼的抗结核方案,利福平,吡嗪酰胺,阿米卡星,还有美罗培南,她离开医院后被法罗培南取代。在随访的第二个月,治疗效果被认为是满意的。
■据我们所知,我们报告了第一例COVID-19感染后播散性结核病的病例报告.结核病可能在COVID-19大流行期间传播和进展,需要更重要的研究来为合并感染提供更好的诊断和治疗方案。
Disseminated tuberculosis is an uncommon but devastating form of tuberculosis, possibly developing with the immune response of patients. COVID-19 infection may produce an immunosuppressive effect with possible implications for tuberculosis dissemination.
A 17-year-old female patient with a history of tuberculous pleurisy presented to the hospital with a high fever and life-threatening dyspnea after contracting a COVID-19 infection. Her condition deteriorated rapidly with grand mal epilepsy and acute gastrointestinal bleeding with a grossly depressed CD4 T-cell count, which was indicative of her profoundly immunosuppressed state. After identifying Mycobacterium tuberculosis in her cerebrospinal fluid and a subcutaneous abscess in her left lower back, she was diagnosed with disseminated tuberculosis involving both lungs, the central nervous system, the terminal ileum, the liver, bilateral adnexal tissue, and subcutaneous soft tissue in accordance with the chest and abdominal CT. Empirical treatment was initiated with dexamethasone (5 mg/day) and an anti-tuberculosis regimen of isoniazid, rifampicin, pyrazinamide, amikacin, and meropenem, which was replaced with faropenem after she left the hospital. The therapeutic effect was considered satisfied in the second month of follow-up.
To the best of our knowledge, we report the first
case report of disseminated tuberculosis after COVID-19 infection. Tuberculosis may disseminate and progress during the COVID-19 pandemic, requiring more significant studies to provide better diagnosis and treatment options for the co-infection.