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患者,女性,32岁。主因间断发热伴上腹痛半年入院。发热时体温波动在38.3℃～39.5℃,伴发冷、畏寒、上腹部疼痛、食欲不振、乏力、盗汗,肌注“青霉素、链霉素”有效。既往无结核及肝炎病史。入院时查体:T38.3℃,P 110次/分,体质消瘦,心肺未见异常,腹平软,肝睥未触及,肝区叩痛。化验查WBC12.0×10~9/L,N 0.75,L 0.25,血沉47mm/h,肝功能正常,肝B型超声波检查示肝右后叶下段可探及6.0cm×2.6cm的低回声区,内部回声不均匀。胸大片、腹平片、钡灌肠均未发现结核灶。初步诊断为细菌性肝脓肿。入院后B超引导下行肝脓肿穿刺术,初次为黄色脓液,约15ml,以后反复多次抽脓,量不多,粘稠,似有干酷样物。数次脓液送检,找到抗酸杆菌。诊断为结核性肝脓肿。每次抽脓
Patient, female, 32 years old. Mainly due to intermittent fever with abdominal pain six months admitted. Fever when the temperature fluctuations in the 38.3 ℃ ~ 39.5 ℃, with cold, chills, upper abdominal pain, loss of appetite, fatigue, night sweats, intramuscular injection of “penicillin, streptomycin” effective. No past history of tuberculosis and hepatitis. Admission examination: T38.3 ℃, P 110 times / min, weight loss, no abnormal heart and lungs, abdominal soft, liver 睥 not touched, liver percussion pain. Laboratory examination WBC12.0 × 10 ~ 9 / L, N 0.75, L 0.25, erythrocyte sedimentation rate 47mm / h, normal liver function, liver B ultrasonic examination showed the lower right lobe of the liver can be detected and 6.0cm × 2.6cm hypoechoic area , The internal echo is not uniform. Large chest, abdominal plain film, barium enema were not found in tuberculosis. Initial diagnosis of bacterial liver abscess. B-guided post-hospitalization of liver abscess puncture, the first yellow pus, about 15ml, after repeated pus, volume is small, thick, it seems dry like sample. Several pus submission, find acid-fast bacilli. Diagnosis of tuberculous liver abscess. Pus each time