误诊为糖尿病周围神经病变的Castleman病一例

A Case of Castleman Disease Misdiagnosed as Diabetic Peripheral Neuropathy

目的对1例疑似糖尿病周围神经病变最终确诊为Castleman病患者的临床资料及诊疗经过进行报道,加深临床医生对糖尿病周围神经病变的认识。方法回顾性分析该科于2016年3月14日收治的1例2型糖尿病合并Castleman病,并对糖尿病合并周围神经病变进行相关的文献复习。结果糖尿病患者出现病程短、快速进展、运动神经障碍大于感觉神经障碍的周围神经病变,应注意鉴别非糖尿病原因导致的周围神经病变,该例患者行淋巴结活检最终确诊为Castleman病,经免疫治疗后周围神经病变临床表现明显好转,跟踪随访4年,周围神经病变症状基本缓解。结论糖尿病周围神经病变临床表现多样,临床诊断是一种排他性诊断,容易被误诊、漏诊。

Objective To report on the clinical data and diagnosis and treatment of a patient with suspected diabetic peripheral neuropathy who was finally diagnosed with Castleman disease,so as to deepen clinicians'understanding of diabetic peripheral neuropathy.Methods A retrospective analysis of a case of type 2 diabetes with Castleman's disease admitted to our department on March 14,2016,and a review of related literature on diabetes with peripheral neuropathy.Results Diabetic patients had peripheral neuropathy with a short course of disease,rapid progress,and greater motor neuropathy than sensory neuropathy.Attention should be paid to identifying peripheral neuropathy caused by non-diabetic causes.This patient underwent lymph node biopsy and was finally diagnosed as Castleman disease.After immunotherapy,the clinical manifestations of peripheral neuropathy have improved significantly.After 4 years of follow-up,the symptoms of peripheral neuropathy were basically relieved.Conclusion The clinical manifestations of diabetic peripheral neuropathy are diverse.The clinical diagnosis is an exclusive diagnosis,which is easy to be misdiagnosed and missed.