title: [Combined application of enzyme-linked immunospot assay, positron emission tomography, and gene chip assay in the diagnosis of a case of chronic disseminated tuberculosis].
abstract: OBJECTIVE
  To highlight the clinical features and diagnosis of chronic disseminated tuberculosis, with emphasizing the usefulness of several recently available diagnostic technologies in this setting.
  
  
  METHODS
  We presented a case of chronic disseminated tuberculosis diagnosed with the combined application of interferon-gamma release assay T-SPOT. TB, 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET), and gene chip assay.
  
  
  RESULTS
  A 53-year-old gentleman who had chronic cough for 7 years and fever for 2 weeks was referred to our hospital for further evaluation. 18F-FDG-PET/CT scan showed increased FDG uptake in multiple lesions involving bilateral lungs, supraclavicular, mediastinal and intro-abdominal lymph nodes and bones, mimicking metastatic malignancy. T-SPOT. TB assay revealed significant responses [ early secreting antigen target 6 (ESAT-6): 3 908 spot forming cells (SFCs)/10(6) peripheral blood mononuclear cells (PBMCs), culture filtrate protein (CFP-10): 3 400 SFCs/10(6) PBMCs]. Subsequent biopsy of supraclavicular lymph node, lung, and ilium revealed granulomas, while culture of the obtained tissue yeilded mycobacteria. Gene chip testing identified M. tuberculosis sensitive to isoniazid and rifampin. After 10 weeks of treatment for tuberculosis, the patient's condition was improved and a second T-SPOT. TB assay showed significantly reduced responses (ESAT-6: 1528 SFCs/10(6) PBMCs; CFP-10: 1460 SFCs/10(6) PBMCs).
  
  
  CONCLUSIONS
  Timely diagnosis of chronic disseminated tuberculosis requires high index of suspicion. T-SPOT. TB assay, PET/CT, and gene chip assay may provide valuable information that facilitates further diagnostic procedures and treatment decision.
authors.affiliation: Department of Infectious Diseases, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Liu
authors.forename: Li-Fan
authors.initials: LF
authors.lastname: Zhang
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Zhu
authors.forename: Zhi-Xian
authors.initials: ZX
authors.lastname: Zhao
mesh_terms: D058501:Enzyme-Linked Immunospot Assay; D006801:Humans; D007963:Leukocytes, Mononuclear; D009169:Mycobacterium tuberculosis; D020411:Oligonucleotide Array Sequence Analysis; D049268:Positron-Emission Tomography; D014376:Tuberculosis / Q000175:diagnosis*