폐외결핵의 임상양상과 진단에 대한 고찰

Abstract

Background: The spectrum of clinical presentations of extrapulmonary tuberculosis (EPT) is so diverse that it may mimic other systemic diseases and often leads physician s to misdiagnosis. Since its diagnosis is largely depended on physician's suspicion of the disease, it would be worthwhile to scrutinize the clinical characteristics of EPT. We retrospectivel evaluated clinical manifestations of 312 patients who were diagnosed as EPT in a tertiary referral hospital.

Methods: The medical records of 312 patients, dianosed as having EPT at Youngdong Severance hospital from January 1997 to December 1999, were reviewed retropsectively.

Results: Total 312 patietns, 149 (47.8%) men and 163 (52.2%) women with age ranged from 13 years to 87 years, were included in this study. The most common site of the involvement was pleura (35.6%). Patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain on infecte site (48.1%). Leukocytosis, anemia, and elevated ESR and CRP were found in 12.8%, 50.3%, 79.3%, and 63.1% of the patients, respectively. Twenty-four percent of patients had underlying medical illnesses such as old age over 60 years, diabetes mellitus illnesses such as old age over 60 years, diabetes mellitus or liver cirrhosis. In 67.3% of patients, tuberculosis was suspected at initial visit. However, tuberculosis was microbiologically proven in only 23.7% of patients. Histopathological diagnosis of EPT was made in 48.7% of patients. The time interval from symptom onset to diagnosis varied, and mean duration was 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographys.

Conclusion: Although EPT had a wide spectrum of clinical manifestations and its diagnostic methods were lack, high index of suspicion could be obtained from chest radiography, localized or systemic symptoms, and several laboratory parameters reviewed in this descriptive study. In case of doubt, early treatment insteaed of awaiting microbiological result may be necessary to aviod the devastating complications.