{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T01:53:40Z","timestamp":1712109220930},"reference-count":25,"publisher":"Akademiai Kiado Zrt.","issue":"1","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["MaSeb"],"published-print":{"date-parts":[[2024,4,2]]},"abstract":"<jats:p>A m\u00e1ra ritk\u00e1n el\u0151fordul\u00f3 tuberkul\u00f3zis (tbc) extrapulmon\u00e1lis manifeszt\u00e1ci\u00f3i el\u0151rehaladott rosszindulat\u00fa daganatok k\u00e9p\u00e9t ut\u00e1nozhatj\u00e1k, jelent\u0151s diagnosztikus dilemm\u00e1kat okozva. A tbc igazol\u00e1sa gyakorta bonyolult, komplex vizsg\u00e1latokat ig\u00e9nyel. Egy fiatal vietn\u00e1mi n\u0151beteg eset\u00e9t ismertetj\u00fck, aki id\u00fclt hasi f\u00e1jdalom, fogy\u00e1s, fejf\u00e1j\u00e1s, bal oldali hemiparesis miatt jelentkezett k\u00f3rh\u00e1zunkban. Az urgens vizsg\u00e1latok hasi folyad\u00e9kgy\u00fclemek, lymphadenopathia \u00e9s peritonealis carcinosis k\u00e9pe mellett az uterushoz asszoci\u00e1lt \u00f6k\u00f6lnyi kismedencei t\u00e9rfoglal\u00f3 k\u00e9pletet, intracranialisan agy\u00f6d\u00e9m\u00e1t \u00e9s metastaticusnak t\u0171n\u0151 g\u00f3cokat \u00e1br\u00e1zoltak. Neurol\u00f3giai, belgy\u00f3gy\u00e1szati, majd pulmonol\u00f3giai klinikai vizsg\u00e1latok \u00e9s kezel\u00e9sek sor\u00e1n el\u0151sz\u00f6r disszemin\u00e1lt gynaecologiai tumor, majd meningealis-, miliaris t\u00fcd\u0151- \u00e9s kiterjedt has\u00fcregi-kismedencei \u00e9rintetts\u00e9ggel j\u00e1r\u00f3 tbc gyan\u00faja fogalmaz\u00f3dott meg. B\u00e1r mycobact\u00e9rium jelenl\u00e9te nem volt igazolhat\u00f3, antituberculoticus- \u00e9s komplex antibiotikus ter\u00e1pi\u00e1t alkalmaztak. Ennek sz\u00f6v\u0151dm\u00e9nyek\u00e9nt Clostridium difficile okozta enterocolitis alakult ki. \u00c1tmeneti \u00e1llapotrosszabbod\u00e1s miatti intenz\u00edv oszt\u00e1lyos kezel\u00e9st k\u00f6vet\u0151en a beteget visszahelyezt\u00e9k k\u00f3rh\u00e1zunk belgy\u00f3gy\u00e1szat\u00e1ra. Itt toxicus megacolon, acut peritonitis alakult ki, emiatt s\u00fcrg\u0151s m\u0171t\u00e9tet v\u00e9gezt\u00fcnk.<\/jats:p><jats:p>A has\u00fcregben granulomatosus peritonitis encapsulans, extr\u00e9m t\u00e1gult, megrepedt taeni\u00e1j\u00fa colon, hyperaemi\u00e1s v\u00e9konyb\u00e9ltraktus, tuboovarialis t\u00e1lyogok voltak l\u00e1that\u00f3k. Oncotomi\u00e1t k\u00f6vet\u0151en salpingo-oophorectomi\u00e1t \u00e9s subtotalis colectomi\u00e1t v\u00e9gezt\u00fcnk, Brooke szerinti ileostom\u00e1t k\u00e9sz\u00edtett\u00fcnk. Az intenz\u00edv oszt\u00e1lyos, majd infektol\u00f3giai kezel\u00e9snek k\u00f6sz\u00f6nhet\u0151en a beteg reconvalescenti\u00e1ja sikeres volt, kiel\u00e9g\u00edt\u0151 \u00e1llapotban emitt\u00e1lt\u00e1k. A specimenek val\u00f3s idej\u0171 PCR-vizsg\u00e1lata sor\u00e1n Mycobacterium DNS nem volt detekt\u00e1lhat\u00f3, v\u00e9g\u00fcl a has\u00fcregi v\u00e1lad\u00e9k \u00e9s granulom\u00e1k mikroszk\u00f3pos vizsg\u00e1lat\u00e1val siker\u00fclt sav\u00e1ll\u00f3 p\u00e1lc\u00e1kat identifik\u00e1lni.<\/jats:p><jats:p>Az eset kapcs\u00e1n \u00e1ttekintj\u00fck az extrapulmon\u00e1lis tbc diagnosztikus lehet\u0151s\u00e9geit \u00e9s ter\u00e1pi\u00e1s neh\u00e9zs\u00e9geit.<\/jats:p>","DOI":"10.1556\/1046.2024.10004","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T09:38:21Z","timestamp":1712050701000},"page":"15-22","update-policy":"http:\/\/dx.doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["Metasztatiz\u00e1l\u00f3 tumor k\u00e9p\u00e9t ad\u00f3 disszemin\u00e1lt tuberkul\u00f3zis Clostridium difficile okozta toxicus megacolonnal sz\u00f6v\u0151d\u00f6tt esete: a diagn\u00f3zis neh\u00e9zs\u00e9gei"],"prefix":"10.1556","volume":"77","author":[{"given":"G\u00e9za","family":"Telek","sequence":"first","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, Seb\u00e9szeti Oszt\u00e1ly, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Csaba","family":"Pol\u00e1nyi","sequence":"additional","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, Seb\u00e9szeti Oszt\u00e1ly, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanni","family":"F\u00fcl\u00f6p","sequence":"additional","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, Seb\u00e9szeti Oszt\u00e1ly, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai Anh Thu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, Seb\u00e9szeti Oszt\u00e1ly, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kriszti\u00e1n","family":"K\u00f3nya","sequence":"additional","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, Seb\u00e9szeti Oszt\u00e1ly, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilona","family":"Bobek","sequence":"additional","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, K\u00f6zponti Aneszteziol\u00f3giai \u00e9s Intenz\u00edv Betegell\u00e1t\u00f3 Oszt\u00e1ly, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edit","family":"Babarczi","sequence":"additional","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, Patol\u00f3gia, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferenc","family":"Ender","sequence":"additional","affiliation":[{"name":"D\u00e9l-pesti Centrumk\u00f3rh\u00e1z, Orsz\u00e1gos Hematol\u00f3giai \u00e9s Infektol\u00f3giai Int\u00e9zet, Szent Istv\u00e1n K\u00f3rh\u00e1z telephely, Seb\u00e9szeti Oszt\u00e1ly, Budapest, Magyarorsz\u00e1g"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"B1","series-title":"Az Emberi Er\u0151forr\u00e1sok Miniszt\u00e9riuma eg\u00e9szs\u00e9g\u00fcgyi szakmai ir\u00e1nyelve a tuberkul\u00f3zis prevenci\u00f3j\u00e1r\u00f3l, diagnosztik\u00e1j\u00e1r\u00f3l, ter\u00e1pi\u00e1j\u00e1r\u00f3l \u00e9s gondoz\u00e1s\u00e1r\u00f3l 2019. 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