Zusammenfassung
Wir beschreiben den seltenen Fall einer Tuberkulose mit überwiegend gastrointestinaler
Symptomatik. Die 52-jährige Patientin stellte sich mit unklaren Unterbauchbeschwerden
und therapierefraktärem Aszites vor. Im CT des Thorax fanden sich rechtsbetont konfluierende
Lymphknoten, im CT des Abdomens neben Aszites noduläre Strukturen in Zökumnähe. Im
Rahmen von Koloskopie, diagnostischer Laparoskopie und Bronchoskopie konnten Biopsien
aus der Kolonmukosa, dem entzündlich veränderten Peritoneum, dem linken Oberlappenbronchus
und den mediastinalen Lymphknotenpaketen entnommen werden. In den peritonealen Biopsien
waren histologisch Granulome mit verkäsenden Nekrosen nachweisbar, in den mediastinalen
Lymphknotenbiopsien Mycobacterium tuberculosis in der PCR. Ferner gelang im Aszitespunktat
in der Kultur die Anzucht von Mycobacterium tuberculosis. Unter Therapie mit Isoniazid,
Rifampicin, Ethambutol und Pyrazinamid kam es zur Besserung von Symptomatik und Befund.
Abstract
We describe a rare case of tuberculosis with mainly gastrointestinal problems. The
52-year-aged female patient came to hospital with unclear pain in the lower abdomen
and ascites that was refractory to therapy. The computed tomography of the thorax
showed right-sided confluating lymphoid nodes, the CT of the abdomen showed ascites
and nodular structures near the coecum. Tissue samples were taken from the mucosa
of the colon, the inflammatory altered peritoneum, the left bronchus of the upper
lobe and the confluating lymphoid nodes in the mediastinum during colonoscopy, diagnostic
laparoscopy and bronchoscopy. The samples from the peritoneum showed granulomas with
caseating necroses in histological slices. Mycobacterium tuberculosis was detected
by PCR in the tissue samples from the lymphoid tissue of the mediastinum. Furthermore,
Mycobacterium tuberculosis grew in cultures from samples of the abdominal ascites.
The symptoms and pathological findings improved under a therapy comprising isoniazid,
rifampicin, ethambutol and pyrazinamid.
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1 Hagen Frickmann und Sven Jungblut sind gleichermaßen als Erstautoren anzusehen.
PD Dr. Joachim Bargon
Medizinische Klinik St. Elisabethen Krankenhaus
Ginnheimer Straße 360487 Frankfurt/Main
Email: bargon@em.uni-frankfurt.de
