肺吸虫病误诊为结核性胸腔积液原因并文献复习  

Causes of Misdiagnosis of Lung Fluke Disease as Tuberculous Pleural Effusion and Literature Review

作　　者：柯娜 李鑫 王新红 王建坤 任涛[3] KE Na;LI Xin;WANG Xinhong;WANG Jiankun;REN Tao(department of laboratory,taihe hospital affiliated hospital of hubei university of medicine,shiyan,hubei 442000,china;department of pathology,taihe hospital affiliated hospital of hubei university of medicine,shiyan,hubei 442000,china;department of pulmonary and critical care medicine,taihe hospital affiliated hospital of hubei university of medicine,shiyan,hubei 442000,china)

机构地区：[1]十堰市太和医院湖北医药学院附属太和医院医学检验科,湖北十堰442000 [2]十堰市太和医院湖北医药学院附属太和医院病理科,湖北十堰442000 [3]十堰市太和医院湖北医药学院附属太和医院呼吸与危重症医学科,湖北十堰442000

出　　处：《临床误诊误治》2024年第10期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：2022年湖北省自然科学基金项目(2022CFB028)。

摘　　要：目的探讨肺吸虫病所致胸腔积液的误诊原因及防范误诊的措施。方法分析1例误诊为结核性胸腔积液的肺吸虫病患者的临床诊疗经过,结合相关文献分析其误诊原因。结果本例主要症状为咳嗽、咳痰、发热,胸部CT提示左侧胸腔积液,结核抗体阳性、红细胞沉降率明显升高。误诊为结核性胸腔积液,给予抗结核治疗效果差。5个月后再次因“咳嗽、咳痰、发热”入院,查外周血、胸腔积液及胸膜组织中嗜酸粒细胞异常升高,患者1年前有生食淡水蟹史,查肺吸虫特异性抗原皮内试验(IDTPA)阳性,诊断为肺吸虫病,误诊时间5个月。确诊后给予吡喹酮治疗4个疗程,患者达到临床治愈。结论外周血、胸腔积液及胸膜活检组织中嗜酸粒细胞升高对肺吸虫病的诊断具有重要价值。详细询问个人史,及时进行IDTPA是肺吸虫病早发现、早诊断的关键。Objective To investigate the causes of misdiagnosis of pleural effusion caused by lung fluke disease and the measures to prevent misdiagnosis.Methods The clinical diagnosis and treatment of 1 patient with lung fluke disease misdiagnosed as tuberculous pleural effusion were analyzed,and the causes of misdiagnosis were analyzed according to relevant literature.Results The main symptoms of this patient were cough,sputum and fever.Chest CT showed left pleural effusion,and positive TB antibody and erythrocyte sedimentation rate increased significantly.It was misdiagnosed as tuberculous pleural effusion,and the effect of anti-tuberculous therapy was poor.Five months afterwards,the patient was admitted to hospital again due to cough,sputum and fever.Abnormal elevation of eosinophil level was detected in peripheral blood,pleural effusion and pleural tissue.The patient had a history of consumption of raw freshwater crab 1 year ago,and the intradermal test for Paragonimus specific antigen(IDTPA)was positive;therefore,the patient was diagnosed as lung fluke disease.The duration of misdiagnosis was 5 months.After diagnosis,the patient was treated with Praziquantel for 4 courses,and the patient achieved clinical cure.Conclusion The elevated eosinophil levels in peripheral blood,pleural effusion and pleural biopsy are of great value in the diagnosis of lung fluke disease.Inquiring about personal history in detail and performing IDTPA in time is the key to early detection and diagnosis of lung fluke disease.

关 键 词：肺吸虫病 胸腔积液 误诊 结核 嗜酸粒细胞 肺吸虫特异性抗原皮内试验 吡喹酮 诊断 

分 类 号：R532.22[医药卫生—内科学]