需要慢性透析的终末期肾病是一种免疫受损状态,会增加结核病发展及其传播的风险。由于出现非特异性或“诱饵”症状的频率很高,并且频繁的肺外受累,结核病的诊断是一项重大挑战。因此,它被正确地标记为“结核病;伟大的模仿者”,因为它可以模仿各种其他疾病过程,导致疾病过程中涉及的子系统的混乱和测试,回来是不正常的,导致恶性循环。错过诊断会导致严重后果,尤其是在一个病人患有一种类似的结核病,由于任何延迟治疗的预后都很差。需要高度诊断怀疑才能及时诊断和治疗疾病,尤其是在资源丰富的环境中,结核病并不常见。这里,我们报告了一位以慢性腹泻和大便失禁为主要主诉的粟粒性肺结核患者,与先前的阴性干扰素-γ释放试验。由于涉及的每个器官系统,船上有多个亚专业,考虑到广泛的差异,包括吸收不良综合征,瘤形成,感染,淀粉样变性,和自身免疫性疾病,因此,进行了许多测试。然而,尽管付出了一切努力,诊断明显延迟,导致病人不幸死亡.病例报告揭示了粟粒性肺结核的独特临床特征,诊断结果,并提醒在适当的临床环境中始终保持结核病的高差异。
End-stage renal disease requiring chronic dialysis is an immunocompromised state which increases the risk of tuberculosis development and its spread. Due to the high frequency of non-specific or \"decoy\" symptoms at presentation and frequent extrapulmonary involvement, diagnosis of tuberculosis is a significant challenge. Therefore, it is correctly labeled as \'Tuberculosis; the great imitator\' as it can mimic various other disease processes, causing confusion and testing of subsystems involved in the disease process, which come back as abnormal, leading to a vicious cycle. Missing the diagnosis leads to grave consequences, especially in a patient with a miliary form of tuberculosis, as the prognosis with any delay in treatment is poor. High diagnostic suspicion is required to promptly diagnose and treat the condition, especially in a resource-rich setting where tuberculosis is uncommon. Here, we report a patient with miliary tuberculosis who presented with a chief complaint of chronic diarrhea and fecal continence, with prior recent negative interferon-gamma release assay testing. Due to every organ system involved, multiple subspecialties were on board, with a broad differential in mind, including malabsorption syndromes, neoplasia, infections, amyloidosis, and autoimmune disorders, and therefore, numerous tests were performed. However, despite all efforts, the diagnosis was delayed significantly, leading to the unfortunate demise of the patient. The
case report sheds light on unique clinical features of miliary tuberculosis, diagnostic findings, and a reminder to always keep tuberculosis high in the differential in an appropriate clinical setting.