گزارش یک مورد آمپیم سلی با تظاهر آمپیم چرکی

مقدمه/ بیان مساله : Tuberculous pleural effusion (TB pleurisy) is the ۲nd most common form of extrapulmonary tuberculosis (EPTB) and the most prevalent cause of pleural effusion in endemic tuberculosis areasTuberculous empyema (TE) is a rare complication of pulmonary tuberculosis. Clinical outcomes of TE are generally believed to be worse compared to those of nontuberculous empyema because of protracted illness, presence of concomitant fibrocavitary lung lesions, high bacillary load, development of bronchopleural fistulae (BPF), and requirement of complicated thoracic surgeriesمعرفی بیمار : A ۵۴-year-old woman with no history of any specific disease came to our center with a complaint of fever and dyspnea that started a week ago. During this period, the patient had visited the clinic and was treated with oral antibiotics, which were not effective. In the investigations, unilateral pleural effusion was observed along with pnemania manifestations in the lung parenchyma. Antibiotic treatment was started for the patient and pleural fluid was aspirated, which was an exudative fluid with ۹۵% polymorphonuclear cells. With the diagnosis of complicated parapneumonic effusion (empyema), chest tube was inserted. Due to the lack of complete drainage of the empyema, after completing the course of antibiotic treatment and improving the general condition, the patient was referred to another treatment center for VATS, which the patient did not perform this referral. Again ۲ months later, she came to the center with complaints of fever, chills and dyspnea, and this time she underwent VATS. In VATS, a granuloma was observed on the pleura and subsequently, the patient underwent pleuroscopy. After biopsy of the granuloma, decortication and nomolysis were performed and two chest tubes were implanted for the patient. While we were waiting for the biopsy results, rheumatological tests including anti nuclear Ab, ASMA, anti LKM ab, and anti ds-DNA were requested, all of which were negative. In pathology, the diagnosis of tuberculous granuloma (tuberculosis) was reported and four anti-tuberculosis drugs were started for the patient. The patient was discharged with a good general condition, and in the follow-up after hospitalization, she is improving without any specific complaints.

کلیدواژه ها:

toberclous empyema ، toberclous granuloma ، complicated parapnemonic effusion