肺结核(TB)在中国很常见,但过去很少有结核病伴凝血障碍和全血细胞减少的报道。在这份报告中,一名70岁的女性因食欲不振而入院,深色尿液,恶心,呕吐,疲劳,双侧下肢水肿;胸部CT提示双肺弥漫性感染性病变,凝血功能障碍,和完全的全血细胞减少症,最初被认为是由严重感染引起的。然而,患者的症状没有通过有效的经验性抗生素治疗得到改善,重复的胸部CT显示肺部病变比以前恶化得更多,凝血障碍和全血细胞减少没有改善。最后,结核病患者使用支气管镜肺泡灌洗技术对结核分枝杆菌(MTB)的酶联免疫斑点试验(ELISPOT)和宏基因组测序(mNGS)检测呈阳性.所以ati-TB是用HRftELfx(异烟肼,0.3gqd;利福喷丁,0.45gbiw;乙胺丁醇,0.75gqd;和左氧氟沙星,0.5gqd)方案。最终,患者的临床症状明显改善,肺部病变被吸收,凝血功能和血细胞计数恢复正常,取得了满意的治疗效果。
Pulmonary Tuberculosis (TB) is common in China, but tuberculosis with coagulation disorders and pancytopenia have rarely been reported in the past. In this report presented, a 70-year-old female was admitted to the hospital with poor appetite, dark urine, nausea, vomiting, fatigue, and bilateral lower limb edema; chest CT suggested diffuse infectious lesions in both lungs, coagulation dysfunction, and complete pancytopenia, which was initially considered to be caused by severe infection. However, the patient\'s symptoms did not improve by potent empiric antibiotics treatment, and a repeat chest CT showed that the lung lesions deteriorated more than before, and coagulation disorders and pancytopenia did not improve. Finally, the TB patient tested positive for enzyme-linked immunospot assay (ELISPOT) and metagenomic sequencing (mNGS) of Mycobacterium tuberculosis (MTB) using bronchoscopic alveolar lavage. So ati-TB was initiated with HRftELfx (isoniazid, 0.3 g qd; rifapentine, 0.45 g biw; ethambutol, 0.75 g qd; and levofloxacin, 0.5 g qd) regimen. Eventually, the patient\'s clinical symptoms improved significantly, the pulmonary lesions were absorbed, and the coagulation function and blood cell count returned to normal, which achieved a satisfactory treatment effect.