血行播散性结核病并发骨髓增生异常综合征一例——文献复习及临床诊治过程分析

血行播散性结核病是一种重症结核病,临床症状常不典型,影像学诊断报告也常常滞后,早期诊断困难。骨髓增生异常综合征(MDS)是一种恶性血液病,早期临床症状和血液系统异常表现一般不具有特异性。血行播散性结核病并发MDS常导致病情互相掩盖,易漏诊、误诊。笔者报道2017年4月首都医科大学附属北京胸科医院以“头晕、乏力3个月,发热2个月” 收治入院的1例患者,初步诊断为血行播散性结核病并发全血细胞严重减少,早期经抗结核药物治疗后临床症状、肺部病变及血液系统表现均一度好转,但后期在肺部病变进一步好转的同时,血液系统异常却再次加重,最终经多次骨髓穿刺检查诊断为血行播散性结核病并发MDS。笔者希望通过对诊治过程的分析讨论,提高临床医生对两病并存的诊断认识,分享治疗经验。

A case of hematogenous disseminated tuberculosis complicated with myelodysplastic syndrome

Hematogenous disseminated tuberculosis is a kind of severe tuberculosis. With hysteresis imaging performances, the symptoms are often untypical, it is difficult to diagnose early. MDS is malignant,without specific clinical manifestations and abnormal performance of the blood system. A case of disseminated tuberculosis complicated with severe hematogenous cell loss in our hospital in April 2017 was reported. The patient presented with “dizziness and fatigue for 3 months, fever for 2 month”was firstly treated with anti-tuberculosis treatment, and then the clinical symptoms, pulmonary lesions and the performance of the blood system improved. The pulmonary lesions were further improvingd, while the blood system abnormalities were aggravated again. Finally, the blood disease was diagnosed as MDS with repeated bone marrow examination. This report aimed to improve the diagnosis and share treatment experience of disseminated tuberculosis complicated with MDS.