一例腰椎管狭窄症患者术后发热并神经功能恶化引发的思考

A Case of Lumbar Spinal Stenosis Complicated with Fever and Peripheral Neuropathy after Decompression and Fusion Surgery

本文报道一例腰椎管狭窄症患者术后症状一过性改善,4周后再次加重,并出现发热、双足下垂等症状,经多科会诊后确诊为腰椎管狭窄症合并POEMS综合征,予化疗及自体造血干细胞移植后症状改善。尽管POEMS综合征属罕见病,同时合并腰椎管狭窄症极为罕见,但遵循严格的先定位、再定性的神经疾病诊断流程,重视临床工作中的疑点,漏诊是可以避免的。

We reported a case of lumbar spinal stenosis,whose symptoms improved temporarily after surgery,but 4 weeks later,the symptoms worsened again,in addition to fever and bilateral foot drop. The patient was diagnosed with POEMS syndrome after multidisciplinary consultation,the symptoms improved with chemotherapy and autologous stem cell transplantation. Although POEMS syndrome is a rare disease,and the combination with lumbar spinal stenosis is an even rarer condition,if we stick to following the diagnostic protocol for neurological diseases to find the location first and then the etiology,without neglectingdoubtful points,we will be able to avoid misdiagnosis in such cases.