一位60歲男性以反覆性腹脹表現

Abstract

結核性腹膜炎病程緩慢且症狀不具有專一性，當潛伏病灶再激活時其死亡率高。本案例是一位60歲男性患有腹脹疼痛、腹水合併發燒症狀，使用經驗性抗生素治療自發性腹膜炎後，其發燒逐漸緩和、但腹脹疼痛仍持續存在，因反覆性腹水增生與發燒症狀，考慮結核菌感染及惡性腫瘤之可能性，行電腦斷層檢查顯示腹膜有多處結節及浸潤，最終由腹腔鏡取得腹膜組織切片確診為結核性腹膜炎，隨即接受抗結核藥物治療，但病人於服藥四日後因併發急性肝衰竭而離世。面對腹脹、腹痛、反覆性腹水及發燒的病人，當抗生素治療成效不佳、臨床狀況與實驗室檢查值無法相呼應時，需將結核菌感染列為鑑別診斷，藉由詳細的身體評估、追蹤檢驗值及必要的切片病理輔助診斷，方能早期確立診斷，以免錯失最佳治療時機。  Tuberculous peritonitis is a slow developed disease with non-specific symptoms. When a latent tuber-culosis lesion is reactivated, its mortality rate is high. In this case, a 60-year-old man was presented with abdominal distension and tenderness. Intermittent fever and intra-abdominal ascites were also noted. After using empiric antibiotics with Imipenem 500 mg + Cilastatin sodium 500 mg to treat spontaneous peritonitis, his fever gradually subsided, but the abdominal distension and tenderness persisted. Due to recurrent ascites and fever, the possibility of tuberculosis infection and malignancy were highly suspected. Abdominal computerized tomography examination was arranged and revealed multiple nodules and infiltrations at the peritoneum. Laparoscopy surgical biopsy of peritoneal tissues were performed and the pathological reports confirmed the diagnosis of tuberculous peritonitis. The patient was treated with anti-tuberculosis drugs, but eventually expired due to acute liver failure four days after anti-tuberculosis drugs prescription. When a patient is presented with abdominal distension and tenderness accompanied with ascites and intermittent fever, antibiotics treatment is ineffective in corresponded to laboratory test data. Tuberculosis infection needs to be considered as one of the differential diagnosis. Detailed physical assessment, follow-up test values tracking and surgical biopsy can help establish an early diagnosis.