多发性骨髓瘤免疫治疗后并发肠结核致不完全性肠梗阻一例

doi:10.16150/j.1671-2870.2026.01.012

摘要/Abstract

摘要：

本文报道1例44岁的女性多发性骨髓瘤（multiple myeloma， MM）患者，经硼替佐米联合地塞米松治疗后病情缓解。后因患者自身原因未按时治疗导致病情进展，予改用CD38单抗治疗后患者病情再次缓解。治疗5个月后，患者突发腹胀，伴肛门停止排气、排便，腹部CT提示肠梗阻，行剖腹探查术、肠切除肠吻合术及腹腔引流术，术后结合T淋巴细胞斑点试验（T-cell spot test， T-SPOT）及病理结果，确诊为孤立性肠结核合并不完全性肠梗阻。予患者四联抗结核治疗（利福平450 mg每日1次口服、异烟肼300 mg每日1次口服、吡嗪酰胺500 mg每日3次口服、链霉素750 mg每日1次肌注）6个月后，患者结核病病情有所改善，但因暂停抗肿瘤治疗致使其MM进展。最终，患者因经济原因放弃治疗，于术后19个月因MM进展死亡。检索数据库中的相关病例显示，1例心脏移植术后发生肠结核的患者在抗结核治疗期间出现MM ，后进展为侵袭性浆细胞白血病，虽经诱导化疗，但患者出现腹膜后出血及全血细胞减少，最终转为姑息治疗。本例病例的诊疗过程提示，处于免疫抑制状态（如MM）的患者，结核感染风险显著增加，其中肠结核等肺外结核相对罕见，且因临床表现不典型，易被漏诊或误诊。此类感染可能干扰抗肿瘤治疗进程，影响患者预后，临床需提高警惕，加强鉴别诊断。

关键词: 多发性骨髓瘤, 肠结核, 化疗, 免疫治疗, 肠梗阻

Abstract:

This study reports a case of a 44-year-old female patient with multiple myeloma (MM). Her condition was initially relieved after treatment with bortezomib combined with dexamethasone. However, due to the patient's failure to adhere to the treatment schedule, the disease progressed. After switching to CD38 monoclonal antibody therapy, the di-sease again achieved remission. After 5 months of treatment, the patient suddenly experienced abdominal distension accompanied by cessation of anal gas and stool passage. Abdominal CT indicated intestinal obstruction. The patient underwent exploratory laparotomy, intestinal resection and anastomosis, and abdominal drainage. Postoperative T-cell spot test (T-SPOT) and pathological results confirmed the diagnosis of isolated intestinal tuberculosis complicated by incomplete intestinal obstruction. The patient received six months of quadruple anti-tuberculosis therapy (rifampicin 450 mg once daily orally, isoniazid 300 mg once daily orally, pyrazinamide 500 mg three times daily orally, streptomycin 750 mg once daily intramuscularly), after which her tuberculosis condition improved. However, due to the suspension of anti-tumor therapy, the MM progressed. The patient discontinued treatment for financial reasons and ultimately passed away 19 months after surgery due to MM progression. A review of relevant cases in the database shows that one patient who developed intestinal tuberculosis after heart transplantation was diagnosed with MM during anti-tuberculosis treatment, which later progressed to aggressive plasma cell leukemia. Although induction chemotherapy was administered, the patient experienced retroperitoneal hemorrhage and pancytopenia, and ultimately transitioned to palliative care. This case highlights that patients in an immunosuppressed state (such as MM) have a significantly increased risk of tuberculosis infection, among which extrapulmonary manifestations, such as intestinal tuberculosis, are relatively rare. Due to its atypical clinical manifestations, it is prone to being missed or misdiagnosed. Such infections may interfere with the course of antitumor therapy and affect patient prognosis. Clinicians should remain vigilant and strengthen differential diagnosis.

Key words: Multiple myeloma, Intestinal tuberculosis, Chemotherapy, Immunotherapy, Intestinal obstruction

中图分类号:

宋瑞, 吴涛, 张茜, 石亚军, 薛锋, 张君玲, 张海英. 多发性骨髓瘤免疫治疗后并发肠结核致不完全性肠梗阻一例[J]. 诊断学理论与实践, 2026, 25(01): 85-89.

SONG Rui, WU Tao, ZHANG Qian, SHI Yajun, XUE Feng, ZHANG Junling, ZHANG Haiying. Incomplete intestinal obstruction caused by intestinal tuberculosis after immunotherapy for multiple myeloma： a case report[J]. Journal of Diagnostics Concepts & Practice, 2026, 25(01): 85-89.

图/表 3

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