第506例——不明原因发热,PET-CT阴性,腹腔内出血

The 506th case:fever of unknown origin,negative PET-CT and hemoperitoneum

患者男,48岁,因间断发热2年就诊。患者间断发热,体温最高39℃,可自行热退,抗菌治疗疗效不佳,入院后无其他伴随症状及阳性体征,曾有体重明显下降,外周血乳酸脱氢酶明显增高,临床高度警惕淋巴瘤,但骨髓穿刺及活检、PET-CT未见明显异常。因患者高热,炎症指标高,铁蛋白增高,伴脾大,考虑高炎症状态,淋巴瘤待除外。给予甲泼尼龙24 mg,每天2次。患者体温正常,但出现血小板进行性下降至33×10^(9)/L。住院期间出现腹腔内出血、出血性休克,急诊手术发现患者为自发性脾破裂,行急诊脾切除术,脾脏病理诊断为弥漫性大B细胞淋巴瘤。

A 48-year-old male was admitted to Peking Union Medical College Hospital presented with intermittent fever for two years.The maximum body temperature was 39℃,and could spontaneously relieve.The efficacy of antibacterial treatment was poor.He had no other symptoms and positive signs.He had a significant weight loss,and the serum lactate dehydrogenase increased significantly.It was highly alert to be lymphoma,but bone marrow smear and pathology,and PET-CT had not shown obvious abnormalities.Considering high inflammatory indicators,increased ferritin and large spleen,the patient had high inflammatory status,and was treated with methylprednisolone.Then the patient′s body temperature was normal,but the platelet decreased to 33×10^(9)/L.During hospitalization,he had suddenly hemoperitoneum and hemorrhagic shock.He was found spontaneous spleen rupture without obvious triggers,and underwent emergency splenectomy.The pathological diagnosis of spleen was diffuse large B-cell lymphoma.