一个47岁的男性,一个已知的酒精性慢性肝病合并门静脉高压症的病例,出现腹胀和呼吸急促的抱怨。乙醇相关性代偿性慢性肝病(CLD)伴门静脉高压和脾肿大的临时诊断,制作了双侧肝性胸腔积液。左侧胸腔积液经三次胸膜穿刺后消退,但是即使经过四到五天的反复治疗性水龙头,右侧积液仍在继续补充,所以猪尾导管留在原处。胸膜液被送去培养,其没有生长任何病原生物。未检测到结核分枝杆菌复合体(MTBC)的基于药筒的核酸扩增测试,进行Ziehl-Neelsen染色,其中没有看到抗酸杆菌,细胞学检查未发现恶性细胞。病人在右侧的猪尾就地出院,20天后,患者再次出现呼吸急促,影像学显示右侧中度胸腔积液。进行了胸腔积液的引流并送去调查,再次发现没有感染性病因。由于右侧积液未消退,患者入院一个月。突然,病人出现呼吸急促,做了胸部X光检查,显示尾纤堵塞;完成尾纤冲洗,袋子被抽干了。患者在经验上开始静脉注射美罗培南500毫克TID,静脉注射替考拉宁400毫克BD,和多粘菌素B500,000IUIVBD。前两个月连续发送胸膜液进行调查,但仍未发现任何感染性病因。猪尾在原地两个月后,胸膜液被送到CBNAAT,在那里没有检测到MTBC,ZN染色显示光滑的耐酸杆菌。样品是培养的,它在血琼脂上72小时内生长出抗酸杆菌,MacConkey琼脂,还有Lowenstein-Jensen媒体.从分离物中进行的线探针测定显示它是脓肿分枝杆菌亚种。脓肿,对大环内酯类抗生素耐药,对氨基糖苷类敏感。脓肿分枝杆菌亚种。从重复的胸腔积液培养中分离出脓肿,患者被建议使用阿米卡星联合治疗,替加环素,还有亚胺培南.患者在建议的治疗下留置猪尾出院;不幸的是,我们失去了患者随访,因为患者再也没有回到我们身边。
A 47-year-old male, a known
case of alcoholic chronic liver disease with portal hypertension, presented with complaints of abdominal distension and shortness of breath. A provisional diagnosis of ethanol-related compensated chronic liver disease (CLD) with portal hypertension and splenomegaly, gross ascites with bilateral hepatic hydrothorax was made. The left-sided pleural effusion subsided after three pleural taps, but the right-sided effusion kept refilling even after four to five days of repeated therapeutic taps, so a pigtail catheter was left in situ. The pleural fluid was sent for culture which did not grow any pathogenic organisms. Cartridge-based nucleic acid amplification tests where Mycobacterium tuberculosis complex (MTBC) was not detected, Ziehl-Neelsen staining was done in which acid-fast bacilli were not seen, and cytology was done where no malignant cells were seen. The patient was discharged with the pigtail in situ on the right side and, after 20 days, the patient again presented with shortness of breath, and imaging revealed moderate right-side pleural effusion. Draining of pleural fluid was done and sent for investigation which again revealed no infective etiology. The patient was admitted to the hospital for one month as the right-sided effusion did not resolve. Suddenly, the patient developed shortness of breath, and a chest X-ray was done, which showed pigtail blockage; pigtail flushing was done, and the bag was drained. The patient was empirically started on IV meropenem 500 mg TID, IV teicoplanin 400 mg BD, and inj polymyxin B 500,000 IU IV BD. The pleural fluid was sent continuously for investigation for the first two months which again did not reveal any infective etiology. After two months of pigtail in situ, the pleural fluid was sent for CBNAAT where MTBC was not detected, and ZN stain showed smooth acid-fast bacilli. The sample was cultured, and it grew acid-fast bacilli in 72 hours on blood agar, MacConkey agar, and Lowenstein-Jensen media. A line probe assay done from the isolate revealed it to be Mycobacterium abscessus subsp. abscessus which was resistant to macrolides and sensitive to aminoglycosides. Mycobacterium abscessus subsp. abscessus was isolated from repeated cultures of pleural fluid, and the patient was advised on a combination treatment of amikacin, tigecycline, and imipenem. The patient was discharged with the indwelling pigtail with the advised treatment; unfortunately, we lost patient follow-up as the patient never returned to us.