結核感染造成肛門管之病例報告

Anal Fistula Tuberculosis: A Case Report

10.7023/TJFM.200912.0224

王基如(Chi-Ju Wang)；周騰達(Tang-Tat Chau)；蔡牧勳(Mu-Shiun Tsai)；張煥禎(Huan-Cheng Chang)；陳子安(Tzu-An Chen)

anal fistula ； extrapulmonary tuberculosis

台灣家庭醫學雜誌

19卷4期（2009 / 12 / 01）

224 - 230

繁體中文

結核分枝桿菌的感染，是屬於全身性感染性疾病，侵犯的部位是以肺部爲主，而感染肺部以外的地方稱爲肺外結核病，以肛門結核來表現則相當罕見。本文報告一名52歲男性，因肛門管併化膿性分泌物接受肛門管手術，術後九個月再度復發，再次安排住院接受肛門瘻管手術，術前胸部X光發現左上肺尖有一個空洞化、厚壁及周邊浸潤的病灶，痰液耐酸性染色及細菌培養證實爲分枝結合桿菌感染，而手術組織病理學檢查發現有結核病慢性肉芽腫性發炎反應及伴有蘭氏巨大細胞存在的特徵，診斷爲一肛門瘻管肺外結核的病例。在給予抗結核菌藥物治療六個月後，痰液抹片及細菌培養均爲陰性；而肛門管直到最近一次的追蹤都沒有再復發。針對反覆肛門管發作的病人，建議皆要懷疑是否有結核菌的感染，應執行胸部X光及管組織病理檢查，以免錯失及延誤病人的診斷及治療。

Anal tuberculosis is an extremely rare disorder. A 52-year-old man presented with a fistula with purulent exudates in anus and he was treated with a fistulectomy; however, the anal fistula recurred 9 months later. The patient was rehospitalized and a chest X-ray showed a 2cm x 2cm in size cavity with a thickened wall and peripheral infiltration at the apex of the left lung. The Ziehl- Neelsen stain and culture of the sputum were positive for Mycobacterium tuberculosis. The anal fistula was removed surgically. The specimen was reviewed and a granulomatous inflammation with central non-caseating necrosis, surrounded by Langhan's giant cells, was noted. After the patient was treated with antituberculous drugs for six months, Mycobacterium tuberculosis was detected neither in the sputum nor sputum culture. He has been well for more than one year. It is important that a chest X-ray and histopathological evaluation be performed in all patients with recurrent anal fistula.