误诊为传染性单核细胞增多症十例原因分析

Analysis of 10 Cases Misdiagnosed with Infectious Mononucleosis in Children

目的探讨其他疾病误诊为传染性单核细胞增多症(infections mononucleosis, IM)的原因及防范措施。方法对10例其他疾病误诊为IM的临床资料进行回顾性分析。结果本组10例中7例因发热伴颈部肿块入院,其中1例伴精神差、食欲下降、消瘦和腹泻;2例因眼睑水肿入院;1例因发热伴咳嗽入院。10例均误诊为IM,误诊时间4~34(20.30±2.84)d。10例中经淋巴结活组织病理检查确诊为亚急性坏死性淋巴结炎4例和化脓性淋巴结炎2例,经骨髓细胞学检查确诊为急性淋巴细胞白血病2例,经骨髓穿刺联合淋巴结活组织病理检查确诊为非霍奇金淋巴瘤1例,经骨髓细胞学检查确诊为噬血细胞综合征1例。确诊为亚急性坏死性淋巴结炎4例中2例给予口服泼尼松治疗,2例未给予特殊治疗,后症状均缓解。确诊为化脓性淋巴结炎2例给予抗感染治疗痊愈。确诊为急性淋巴细胞白血病2例予以化学治疗后缓解出院。确诊为非霍奇金淋巴瘤1例予以化学治疗等后死亡。确诊为嗜血细胞综合征1例给予化学治疗后好转出院。结论发热、咽峡炎、淋巴结增大、肝脾增大、眼睑水肿、外周淋巴细胞及异型淋巴细胞增高为IM典型临床表现,但不是其特定独有表现,故临床上对其诊断除结合典型临床表现外,还应进一步完善各项检查,对与其相关疾病的知识也应进一步学习和了解,以降低误诊率。

Objective To analyze the causes and preventive measures of other diseases misdiagnosed as infectious mononucleosis(IM). Methods Clinical data of 10 patients with other diseases misdiagnosed as IM in our hospital were retrospectively analyzed. Results Seven of the 10 patients in this group were admitted to our hospital because of a neck mass with fever. Of them, one patient had poor mental function, loss of appetite, weight loss and diarrhea. Two patients were admitted to our hospital for eyelid edema, and one was admitted due to fever and cough. All were misdiagnosed as IM, and the duration of misdiagnosis was 4-34(20.30±2.84) d. In 10 patients misdiagnosed as IM, there were 4 patients diagnosed with subacute necrotizing lymphadenitis by lymph node biopsy, 2 patients with suppurative lymphadenitis by lymph node biopsy, 2 patients with acute lymphoblastic leukemia by bone marrow cytology, 1 patient with non-Hodgkin’s lymphoma by bone marrow aspiration combined with lymph node biopsy, and 1 patient with hemophagocytic syndrome by bone marrow cytology. In 4 patients diagnosed with subacute necrotizing lymphadenitis, 2 patients received oral administration of prednisone, and 2 patients received no special treatment and the symptoms were relieved. Two patients with suppurative lymphadenitis recovered after anti-infective treatment. Two patients diagnosed with acute lymphoblastic leukemia were discharged from hospital for improved symptoms after chemotherapy. One patient diagnosed with non-Hodgkin’s lymphoma died after treatment with chemotherapy. One patient diagnosed with hemophagocytic syndrome was discharged from hospital with stable condition after chemotherapy. Conclusion Fever, angina, lymphadenopathy, hepatosplenomegaly, eyelid edema, as well as higher peripheral lymphocytes and atypical lymphocytes, are typical clinical manifestations of IM but not the unique manifestations in clinical settings. Therefore, in addition to typical clinical symptoms, the relevant examinations should be further improved, and the knowledge related to the diseases should be further studied and understood to reduce the rate of misdiagnosis in clinical practice.