类风湿关节炎合并T-细胞大颗粒淋巴细胞白血病1例及文献复习

Rheumatoid arthritis complicated with T-cell large granular lymphocytic leukemia:A case report and literature review

目的探讨类风湿关节炎(rheumatoid arthritis,RA)合并T-细胞大颗粒淋巴细胞白血病(T-cell large granular lymphocytic leukemia,T-LGLL)的临床特点。方法回顾性分析南京医科大学第四附属医院收治的1例RA合并T-LGLL患者的临床资料、诊疗经过并复习相关文献。结果患者为男性,64岁,多关节肿痛10年,乏力2年。伴有中性粒细胞减少、脾大。结合患者病史、体格检查及辅助检查,入院诊断:RA,费尔蒂综合征(Felty’s syndrome,FS)。后完善相关辅助检查并结合其临床表现,确诊为T-LGLL。给予免疫抑制剂、糖皮质激素等对症治疗后,患者乏力症状改善,无关节肿痛。结论RA和T-LGLL可能存在类似的发病途径。对RA患者,当发展为FS时,需警惕合并T-LGLL可能。

Objective To explore the clinical characteristics of rheumatoid arthritis(RA)complicated with T-cell large granular lymphocytic leukemia(T-LGLL).Methods The study was aiming to retrospectively analyze the clinical data,diagnosis and treatment process of a RA patient complicated with T-LGLL admitted to The Fourth Affiliated Hospital of Nanjing Medical University,and reviewing related literatures.Results The patient was a 64-year-old man with multiple joint swelling and pain for 10 years and fatigue for 2 years.The disease course was complicated with neutropenia and splenomegaly.In combination with the patient’s medical history,physical examination and auxiliary examination,the following findings of admission diagnosis were made:RA,Felty’s syndrome(FS).The admission diagnosis results(RA,and Ferty’s syndrome[FS])were made in combination with the case history,physical examination,and auxiliary examination.The patient was confirmed to have T-LGLL after supplementing relevant auxiliary examination and combining corresponding clinical manifestations.The patient’s fatigue symptoms were improved without joint swelling and painafter the symptomatic treatment of immunosuppressant and glucocorticoid.Conclusion For patients with RA,RA and T-LGLL may have similar pathogenesis.It is necessary to be alert to the possibility of T-LGLL when developing FS.