继发性噬血细胞淋巴组织细胞增多症与甲氨蝶呤毒性-一个诊断难题。

JRSM Open Pub Date : 2023-04-01 DOI:10.1177/20542704231155815

Leah Hawkins, Jack Gibbs, Connor MacMillan

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引用次数: 1

摘要

74岁女性，类风湿关节炎背景，每周接受甲氨蝶呤治疗。水肿、呼吸困难、恶病质、黄疸。血液显示全血细胞减少症、高铁血症、高胆红素血症、低白蛋白血症和低叶酸血症。影像显示右侧大量胸腔积液，需要治疗性抽吸和脾肿大。骨髓抽吸显示噬血细胞症。鉴别诊断包括甲氨蝶呤毒性(MTXT)和噬血细胞淋巴组织细胞增多症(HLH)。已开始对MTXT进行管理，同时仍在继续对可能的HLH进行调查。

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Secondary haemophagocytic lymphohistiocytosis vs methotrexate toxicity - a diagnostic conundrum.

A 74-year-old female with a background of rheumatoid arthritis, managed with weekly methotrexate, was admitted with; oedema, dyspnoea, cachexia and jaundice. Bloods revealed pancytopenia, hyperferritinaemia, hyperbilirubinaemia, hypoalbuminaemia and hypofolataemia. Imaging showed a large right-sided pleural effusion, requiring therapeutic aspiration, and splenomegaly. Bone marrow aspirate revealed haemophagocytosis. Differential diagnoses included methotrexate toxicity (MTXT) and haemophagocytic lymphohistiocytosis (HLH). Management was initiated for MTXT whilst ongoing investigation for possible HLH continued.

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来源期刊

JRSM Open

自引率

0.00%

发文量

审稿时长

12 weeks

期刊介绍： JRSM Open is a peer reviewed online-only journal that follows the open-access publishing model. It is a companion journal to the Journal of the Royal Society of Medicine. The journal publishes research papers, research letters, clinical and methodological reviews, and case reports. Our aim is to inform practice and policy making in clinical medicine. The journal has an international and multispecialty readership that includes primary care and public health professionals.