摘要
患者女性,18岁。喘憋,淋巴结肿大,胸部CT以肺囊性变为主要表现,查IgG 38.00 g/L,红细胞沉降率(ESR)92 mm/1h,超敏C反应蛋白(CRP)16.75 mg/L,抗SSA抗体阳性,最初考虑干燥综合征,予患者泼尼松(30 mg/d)、羟氯喹(0.2 g,2次/d)、吗替麦考酚酯(0.75 g,2次/d)治疗2月余,效果不佳,最终经淋巴结活检病理诊断为Castleman病(浆细胞型),予TCP方案[沙利度胺100 mg每晚1次+环磷酰胺400 mg(第1、8、15、22天)+泼尼松50 mg(第1~2、8~9、15~16、22~23天)]化疗6个月后,患者体重指数保持稳定,食欲正常,运动量较前改善,复查IgG 16.23 g/L,ESR 18 mm/1h,超敏CRP 3.51 mg/L。Castleman病是一种较为少见的淋巴增殖性疾病,本例患者诊断疑难,故对不能完全解释的临床现象或治疗效果不佳的难治病例,应及时思考诊断与治疗的合理性,为患者争取正确诊断、早期治疗的机会。
作者
顾莹珍
何石萍
吴娟娟
乔琳
赵丽丹
李梦涛
赵岩
曾小峰
Gu Yingzhen;He Shiping;Wu Juanjuan;Qiao Lin;Zhao Lidan;Li Mengtao;Zhao Yan;Zeng Xiaofeng(Department of Internal Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,National Clinical Research Center for Dermatologic and Immunologic Disease,Ministry of Science&Technology,State Key Laboratory of Complex Severe and Rare Diseases,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,Beijing 100730,China;Department of Neurology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华内科杂志》
CAS
CSCD
北大核心
2023年第6期711-713,共3页
Chinese Journal of Internal Medicine