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NEJM：手指结核-病例报道

2018-09-20 xing.T MedSci原创

手指结核肿胀疼痛
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进一步的调查显示，最近前往中国旅行的患者丈夫在回家后不久就开始咳嗽。他随后被诊断为活动性肺结核。尽管手指感染是结核病罕见的肺外表现，但它是免疫抑制患者的重要考虑因素。

患者为一名42岁的女性，左手小指出现肿胀和疼痛1周。她报告没有发生相关的创伤。她患有系统性红斑狼疮，正在接受吗替麦考酚酯和强的松治疗。

对受影响的手指检查显示软组织肿胀，伴有红斑和发热，近端和远端指间关节之间最为突出，指尖正常（如图A所示）。X线和磁共振成像显示软组织肿胀但没有骨质异常。在Fite染色后检查深层真皮的活检标本发现出许多抗酸杆菌（如图B箭头所示）。组织样品的培养物生长出结核分枝杆菌。胸部X线摄影结果正常。在开始免疫抑制治疗之前，患者进行了纯化的蛋白质衍生物皮肤试验; 结果阴性。


进一步的调查显示，最近前往中国旅行的患者丈夫在回家后不久就开始咳嗽。他随后被诊断为活动性肺结核。尽管手指感染是结核病罕见的肺外表现，但它是免疫抑制患者的重要考虑因素。

该患者接受4个抗结核药物的方案治疗9个月，症状完全消除。

原始出处：

Jennifer Mandal,et al. Tuberculosis of the Finger.N Engl J Med 2018; https://www.nejm.org/doi/full/10.1056/NEJMicm1800879

本文系梅斯医学（MedSci）原创编译整理，转载需授权！

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    2018-09-30 xsm918

    #手指结核#

    0

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    2018-09-22 smartxiuxiu

    少见

    0

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    2018-09-21 huhuaidong387

    #结核#

    0

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    2018-09-20 执迷不悔

    值得学习

    0