播散性结核病(TB)是一种罕见的疾病,主要发生在免疫缺陷患者中。它以结核分枝杆菌的血源性或淋巴播散为特征,引起任何器官系统的结核性感染。这里,我们报告一例播散性结核累及肺部,肝脏,脊柱,纵隔,一个有免疫能力的人的前列腺.本患者在健康检查中发现肝脏肿块,没有任何症状。在接下来的两年里,进一步检查发现肺部有多处病变,纵隔,脊柱,还有前列腺.影像学检查,如腹部CT增强,F-18FDG-PET/CT,和放射性核素骨扫描,提示诊断为恶性肿瘤或转移性肿瘤。此外,肝肿块活检的组织病理学结果,纵隔肿块,前列腺肿块表现为肉芽肿性炎症。因此,宏基因组下一代测序(mNGS)用于确认诊断。在脊柱手术切除标本和支气管肺泡灌洗液(BALF)中同时检测到结核分枝杆菌复合体,指示播散性结核病的诊断。mNGS是一种新兴的分子诊断技术,其在播散性结核病中的应用鲜有报道。我们强调,即使在有免疫能力的患者中,也应考虑传播的结核病,当诊断困难时可以进行mNGS。
Disseminated tuberculosis (TB) is a rare disease and mainly occurs in immunodeficient patients. It is marked by hematogenous or lymphatic dissemination of Mycobacterium tuberculosis, causing tuberculous infection involving any organ system. Here, we report a case of disseminated TB involving lung, liver, spine, mediastinum, and prostate in an immunocompetent man. The present patient found a hepatic mass without any symptom during health examination. In the next 2 years, further examinations revealed multiple lesions in the lung, mediastinum, spine, and prostate. Imaging examinations, such as contrast-enhanced abdominal CT, F-18 FDG-PET/CT, and radionuclide bone scan, suggested the diagnosis of malignancy or metastatic tumor. Furthermore, histopathological results of the biopsies of the hepatic mass, mediastinal mass, and prostatic mass demonstrated granulomatous inflammation. Therefore, metagenomic next-generation sequencing (mNGS) was utilized to confirm the diagnosis. Mycobacterium tuberculosis complex was simultaneously detected in the spinal surgical resection specimens and bronchoalveolar lavage fluid (BALF), indicating the diagnosis of disseminated TB. mNGS is an emerging molecular diagnostic technology, and its application in disseminated TB has been rarely reported. We highlight that disseminated TB should be considered even in an immunocompetent patient, and mNGS can be performed when the diagnosis is difficult.