老年男性系统性红斑狼疮长期误诊分析

Misdiagnosis Analysis of One Elderly Patient with Systemic Lupus Erythematosus

目的探讨临床表现不典型的系统性红斑狼疮(systemic lupus erythematosus,SLE)的临床特点。方法对我院收治的1例误诊为淋巴结结核的SLE患者临床资料进行回顾性分析。结果患者为78岁男性,因泡沫尿、夜尿增多伴反复口腔溃疡1年入我院。3年前因多发纵隔淋巴结增大,行淋巴结活检诊断为淋巴结结核,转结核病专科医院予抗结核治疗效果不佳。入我院后查抗核抗体和抗双链DNA抗体阳性,外周血三系降低,并结合关节痛、反复口腔溃疡等多系统受累表现,确诊为SLE。予糖皮质激素治疗,病情明显改善。结论部分SLE患者症状不典型,尤以男性为主。对于不明原因的外周血三系下降伴口腔溃疡、关节痛、淋巴结增大的老年患者,应警惕SLE可能,及时行免疫学检查,避免临床漏误诊。

Objective To discuss diagnosis and treatment of atypical systemic lupus erythematosus （SLE）.Methods Clinical data of one SLE patient misdiagnosed as having lymph node tuberculosis was retrospectively analyzed.Results A 78-years-old male was admitted for foamy urine, increasing nocturia and repeat oral ulcer for one year.The patient was misdiagnosed as having lymph node tuberculosis for multiple mediastinal lymph nodes enlargement 3 years ago by result of lymph node biopsy, but symptoms failed to alleviate by anti-tuberculosis therapy after transferring to tuberculosis hospital.After admission in our hospital, results of antinuclear antibodies and anti-double-stranded DNA antibody were positive, and leukocytes, erythrocytes and hemoglobin levels in peripheral blood were decreased, and he had multiple organ injuries such as joint pain and repeat mouth ulcers, and then SLE was confirmed.Symptoms were relieved, and immunological indexes and leukocytes, erythrocytes and hemoglobin levels in peripheral blood were significantly improved after glucocorticoids treatment.Conclusion Part of SLE patients have atypical symptoms, especially in male patients, and therefore it is easily misdiagnosed.Clinicians should consider a diagnosis of SLE for elderly patients with unexplained decline in leukocytes, erythrocytes and hemoglobin levels in peripheral blood associated by oral ulcers, joint pain and lymph nodes enlargement, and immunological test should be performed as early as possible to avoid misdiagnosis and missed diagnosis.