肺吸虫病误诊为结核性胸腔积液一例  

A case of lung fluke disease misdiagnosed as tuberculous pleural effusion

作　　者：成丹 王骁 李洪波 任涛[2] 王建坤 Cheng Dan;Wang Xiao;Li Hongbo;Ren Tao;Wang Jiankun(Department of Blood Transfusion Medicine,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,China;Department of Pulmonary and Critical Care Medicine,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,China)

机构地区：[1]太和医院(湖北医药学院附属太和医院)输血医学科,十堰市442000 [2]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,十堰市442000

出　　处：《中华实验和临床感染病杂志（电子版）》2024年第3期182-186,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：2022年湖北省自然科学基金项目(No.2022CFB028)。

摘　　要：目的探讨以胸腔积液为主要临床表现的肺吸虫病(LFD)的临床特征及实用诊断方法。方法报告1例就诊于十堰市太和医院的49岁男性患者,以“双侧下胸部间断钝痛、呼吸困难1年”为主诉,影像学表现为左侧胸腔积液的LFD患者的临床误诊经过,并分析其误诊原因。结果本例以胸腔积液为主要表现的LFD患者被误诊为结核性胸腔积液长达1年余,后经内科胸腔镜发现其胸膜组织中存在嗜酸性粒细胞,以及外周血嗜酸性粒细胞绝对值高达2.64×10^(9)/L;结合患者肺吸虫抗原皮试(IDTPA)及肺吸虫血清抗体酶联免疫吸附试验(ELISA)阳性结果,确诊为LFD。后患者院外遵医嘱口服吡喹酮(25mg·kg^(-1)·次^(-1)、3次/d)4个疗程,达到临床治愈。结论外周血及胸膜活检组织中嗜酸性粒细胞升高对LFD的诊断和疗效分析有重要意义。详细询问个人史,及时进行IDTPA是LFD早发现、早诊断的关键。Objective To investigate the clinical features and practical diagnostic method of lung fluke disease(LFD)that presented with pleural effusion as the main clinical manifestation.Methods The clinical diagnosis and treatment of a 49-year-old male patient with LFD who complained of intermittent dull pain and dyspnea in bilateral lower chest for one year with radiological findings of left pleural effusion and admitted to Taihe Hospital of Shiyan City,and the causes of misdiagnosis were analyzed.Results This LFD patient with pleural effusion was misdiagnosed as tuberculous pleural effusion for longer than one year.There was abnormal elevation of eosinophils in pleural tissue,and the absolute count of eosinophils in peripheral blood was as high as 2.64×10^(9)L.Finally.combined with the positive results of intradermal tests for Paragonimus-specific antigens(IDTPA)and enzymelinked immunosorbent assay(ELISA)of serum antibodies to Paragonimus,the diagnosis of lung fluke disease was confirmed.The patient received praziquantel(25 mg·kg^(-1)·times^(-1),3 times a day)for 4 courses outside the hospital according to the doctor's advice,and demonstrated clinical improvement.Conclusions Elevated eosinophils in peripheral blood and pleural biopsies are important for the diagnosis and therapeutic effect analysis ofLFD.Detailed inquiry of personal history and timely IDTPA are the keys to early diagnosis of LFD.

关 键 词：胸腔积液 肺吸虫病 嗜酸性粒细胞 肺吸虫特异性抗原皮试 吡喹酮 

分 类 号：R532.2[医药卫生—内科学]