Chinese Journal of Antituberculosis ›› 2022, Vol. 44 ›› Issue (6): 576-581.doi: 10.19982/j.issn.1000-6621.20210648
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LIU Xin, GUO Le, LI Jun-xiao, CHEN Qi-liang, WU Qian-hong()
Received:
2021-11-12
Online:
2022-06-10
Published:
2022-06-01
Contact:
WU Qian-hong
E-mail:15902969531@126.com
LIU Xin, GUO Le, LI Jun-xiao, CHEN Qi-liang, WU Qian-hong. Clinical analysis of six cases of Brucella spondylitis misdiagnosed as lumbar tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(6): 576-581. doi: 10.19982/j.issn.1000-6621.20210648
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病例 | 性别 | 年龄 (岁) | 病程 | 临床表现 | 接触及既往史 | 实验室检查 | 影像学表现 | 确诊方法 | 治疗及预后 | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 女性 | 54 | 2个月 | 腰痛伴双下肢放射痛,双下肢直腿抬高试验阳性,双下肢肌力Ⅲ级 | 牛羊接触史 | 虎红平板凝集试验阳性,布鲁氏菌IgG阳性,血清凝集试验1:400,T-SPOT.TB试验阳性,血红细胞沉降率35mm/1h,C反应蛋白2.7mg/L | 骶1椎体边缘毛糙,局部见破坏征象,周围软组织肿胀;腰5~骶1椎间隙狭窄,腰5~骶1椎间盘组织向椎体后方突出,硬膜囊受压,椎管狭窄( | 虎红平板凝集试验及血清凝集试验阳性 | 给予H-R-Z-E抗结核治疗1周后行腰5~骶1后路病灶清除、椎管减压及钉棒内固定术;术后给予多西环素0.2g/d;R 0.6g/d治疗4周后疼痛缓解 | ||||
2 | 男性 | 56 | 12个月 | 腰痛,弯腰拾物试验阳性,双下肢直腿抬高试验阳性 | 牛羊及布鲁氏菌病患者接触史,甲状腺功能减退病史 | 虎红平板凝集试验阳性,布鲁氏菌IgG阳性,血清凝集试验1:160,T-SPOT.TB试验阳性,血红细胞沉降率5mm/1h,C反应蛋白12.40mg/L,嗜酸性粒细胞6.2%,白细胞计数3.65×1012/L | 腰2~3椎体前缘变尖,相对缘见片状长T1、长T2、压脂序列高信号,腰2~3椎旁软组织及椎间盘间片状压脂高信号( | 虎红平板凝集试验及血清凝集试验阳性 | 给予H-R-Z-E抗结核治疗2周症状无缓解后,给予多西环素0.2g/d、R 0.6g/d治疗2周后疼痛减轻 | ||||
3 | 男性 | 57 | 2个月 | 腰痛,弯腰拾物试验阳性 | 布鲁氏菌病患者接触史 | 虎红平板凝集试验阳性,布鲁氏菌IgG阳性,血清凝集试验1:160,结核蛋白芯片阳性,血红细胞沉降率39mm/1h,C反应蛋白105.20mg/L | 腰2椎体局部骨密度增高,椎体周围软组织肿胀( | 虎红平板凝集试验及血清凝集试验阳性 | 给予H-R-Z-E抗结核治疗2周症状无缓解,给予多西环素0.2g/d、R 0.6g/d治疗2周后疼痛减轻 | ||||
病例 | 性别 | 年龄 (岁) | 病程 | 临床表现 | 接触及既往史 | 实验室检查 | 影像学表现 | 确诊方法 | 治疗及预后 | ||||
4 | 男性 | 62 | 1个月 | 高热,39.5℃,波状热,乏力、盗汗、腰痛,弯腰拾物试验阳性 | 牛羊接触史 | 虎红平板凝集试验阳性,布鲁氏菌IgG阳性,血清凝集试验1:160,血红细胞沉降率10mm/1h,C反应蛋白12.20mg/L | 腰3~4椎前缘变尖,椎间隙狭窄,可见斑片状短T1、长T2信号影,脂肪抑制序列呈高信号,增强扫描明显强化, T2加权成像显示部分椎间盘信号降低,腰3~4椎间盘组织向椎体后方突出,硬膜囊轻度受压,椎管无狭窄( | 虎红平板凝集试验及血清凝集试验阳性 | 给予H-R-Z-E抗结核治疗2周症状无缓解,后给予多西环素0.2g/d、R 0.6g/d治疗4周后体温恢复正常,疼痛减轻 | ||||
5 | 女性 | 66 | 1个月 | 腰痛,左下肢直腿抬高试验阳性,左侧4字试验阳性 | 牛羊接触史 | 虎红平板凝集试验阳性,布鲁氏菌IgG阳性,血清凝集试验1:200,血红细胞沉降率54mm/1h,C反应蛋白26.00mg/L | 腰4~5椎体相对缘可见虫噬样骨质破坏区,并可见砂砾样死骨,周围可见脓性低密度影( | 虎红平板凝集试验及血清凝集试验阳性 | 给予H-R-Z-E抗结核治疗2周症状无缓解,后给予多西环素0.2g/d、R 0.6g/d治疗2周后疼痛减轻 | ||||
6 | 男性 | 81 | 20d | 腰痛 | 牛羊接触史,陈旧性肺结核病史,2型糖尿病 | 虎红平板凝集试验阳性,布鲁氏菌IgG阳性,血清凝集试验1:200,T-SPOT.TB阳性,血红细胞沉降率56mm/1h,C反应蛋白5.0mg/L | 腰4~5、腰5~骶1椎间盘突出,腰4~5椎体骨质内及椎体周围异常信号灶,腰5~骶1平面椎旁软组织水肿,腰椎退行性病变( | 虎红平板凝集试验及血清凝集试验阳性 | 给予H-R-Z-E抗结核治疗2周症状无缓解,后给予多西环素0.2g/d、R 0.6g/d治疗2周后疼痛减轻 |
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