[第 506 个病例:不明原因的发热、PET-CT 阴性和腹腔积血]。

F P Guo, Y Cong, C W Jia, Y Ge, T S Li, Z Y Liu
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引用次数: 0

摘要

北京协和医院收治了一名48岁的男性患者,间歇性发热已有两年。最高体温 39 ℃,可自行缓解。抗菌治疗效果不佳。他没有其他症状和阳性体征。体重明显减轻,血清乳酸脱氢酶明显升高。高度怀疑是淋巴瘤,但骨髓涂片、病理和 PET-CT 均未显示明显异常。考虑到炎症指标高、铁蛋白增高、脾脏大,患者处于高炎症状态,给予甲基强的松龙治疗。随后,患者体温正常,但血小板降至 33×109/L。住院期间,他突然出现腹腔积血和失血性休克。在无明显诱因的情况下发现自发性脾破裂,急诊行脾切除术。脾脏病理诊断为弥漫大 B 细胞淋巴瘤。
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[The 506th case: fever of unknown origin, negative PET-CT and hemoperitoneum].

A 48-year-old male was admitted to Peking Union Medical College Hospital presented with intermittent fever for two years. The maximum body temperature was 39 ℃, and could spontaneously relieve. The efficacy of antibacterial treatment was poor. He had no other symptoms and positive signs. He had a significant weight loss, and the serum lactate dehydrogenase increased significantly. It was highly alert to be lymphoma, but bone marrow smear and pathology, and PET-CT had not shown obvious abnormalities. Considering high inflammatory indicators, increased ferritin and large spleen, the patient had high inflammatory status, and was treated with methylprednisolone. Then the patient's body temperature was normal, but the platelet decreased to 33×109/L. During hospitalization, he had suddenly hemoperitoneum and hemorrhagic shock. He was found spontaneous spleen rupture without obvious triggers, and underwent emergency splenectomy. The pathological diagnosis of spleen was diffuse large B-cell lymphoma.

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