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首页> 外文期刊>Cureus. >Disseminated Tuberculosis Involving Lung, Peritoneum, and Endometrium in an Immunocompetent 17-Year-Old Patient
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Disseminated Tuberculosis Involving Lung, Peritoneum, and Endometrium in an Immunocompetent 17-Year-Old Patient

机译：涉及肺癌，腹膜和子宫内膜的促进结核病在免疫活性的17岁患者中

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A 17-year-old Guatemalan female with a recent history of spontaneous abortion requiring dilation and curettage at 16 weeks' gestation presented two weeks post-procedure to a pediatric hospital for three days of worsening generalized abdominal pain, diarrhea, fevers, and cough. The patient's vital signs showed hypoxia, tachypnea, tachycardia, and hypotension; she was alert and oriented with a thin body habitus and suprapubic abdominal tenderness without rebound, guarding, or hepatosplenomegaly. She had no crackles, rales, or wheezing on lung examination. Labs revealed neutrophilic leukocytosis, acute kidney injury, transaminitis, and coagulopathy. Pelvic ultrasound demonstrated a septated pelvic fluid collection with an endometrial thickening. CT abdomen and pelvis showed significant nodular omental thickening and ascites. CT angiogram of the chest demonstrated an apical lung cavity and bilateral micro-nodularity without lymphadenopathy. Due to concern for septic shock secondary to endometritis, the patient was started on broad-spectrum antibiotics and intubated for acute hypoxic respiratory failure. Repeat dilation and evacuation revealed degenerative first trimester products of conception and necrotizing granulomatous endometritis with Mycobacterium tuberculosis (M. tuberculosis)?bacteria. Paracentesis indicated?tuberculosis (TB) in ascites fluid, and bronchoalveolar lavage (BAL) showed pulmonary TB. Human immunodeficiency virus (HIV) screen and serum QuantiFERON?-TB Gold testing were negative. Rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy was initiated alongside piperacillin-tazobactam for the treatment of both disseminated TB and septic abortion. She was extubated with hemodynamic stability, but fevers persisted. Repeat fallopian tube fluid sampling after five weeks of RIPE indicated numerous acid-fast bacilli. The patient’s septic clinical picture clouded her TB diagnosis as it appeared unusual that a healthy 17-year-old would concurrently have a septic abortion and disseminated TB; the lack of lymphadenopathy on CT scan also contributed to diagnostic uncertainty. Among patients from endemic regions, TB is a cause of spontaneous abortion. Conversely, during pregnancy, progesterone suppresses the T-helper 1 (Th1) proinflammatory response and increases susceptibility to TB. Peripartum women are at higher risk for disseminated TB, and postpartum women are twice as likely to experience reactivation of latent TB than nonpregnant women. Disseminated TB must be considered in pregnant adolescents presenting with appropriate clinical characteristics and imaging findings.
机译：一个17岁的危地马拉女性，最近的历史历史悠久的自发流产历史，需要在16周的妊娠期妊娠期妊娠晚上为一名儿科医院呈现两周，以使广泛性的腹痛，腹泻，烧伤和咳嗽萎缩三天。患者的生命体征显示缺氧，千曲肿，心动过速和低血压;她的警觉，面向瘦身栖息地和耻骨上的腹部压痛，没有反弹，守卫或肝脾肿大。她没有噼啪作响的噼啪声，兰花或喘息。实验室揭示了中性白细胞增多症，急性肾损伤，越野炎和凝血病。盆腔超声证明了具有子宫内膜增稠的胶水盆腔流体收集。 CT腹部和骨盆显示出显着的结节性题为增厚和腹水。胸部的CT血管造影显示出无淋巴结病的双侧肺腔和双侧微结节。由于对子宫内膜炎继发的脓毒症休克的关注，患者开始在广谱抗生素上并向急性缺氧呼吸衰竭提取。重复扩张和疏散揭示了孕概念和坏死性肉芽肿子宫内膜炎的退行性第一孕孕术（M.结核病）？细菌。 Paraceis is表明腹水液中的结核（TB），支气管肺泡灌洗（BAL）显示肺结核。人类免疫缺陷病毒（HIV）筛网和血清量子α-TB金测试是阴性的。利福平，异烟肼，吡嗪酰胺和乙胺醇（成熟）治疗与哌啶蛋白-Tazobactam一起启动，用于治疗散发的结核病和脓毒症流产。她被血液动力学稳定拔管，但幸福持续存在。在成熟的五周后重复输卵管液抽样，表明众多酸快速杆菌。患者的化粪池临床影像覆盖了她的结核病诊断，因为它看起来与健康17岁的人同时具有脓毒症流产和传播结核病; CT扫描上缺乏淋巴结病也有助于诊断不确定性。在流行区域的患者中，TB是一种自发流产的原因。相反，在妊娠期间，孕酮抑制了T-辅助1（TH1）促炎反应，并增加了对TB的敏感性。 Peripartum妇女的发育结核病风险较高，产后妇女的妇女可能遭受潜伏的妇女的重新激活的可能性。在怀孕的青少年中呈现出来的TB，呈现适当的临床特征和成像结果。

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