2023年山东省潍坊市1例布鲁氏菌病并发弥漫性大B细胞淋巴瘤病例个案分析

Analysis on a case of brucellosis complicated with diffuse large B-cell lymphoma in Weifang,Shandong,2023

目的 探讨布鲁氏菌病(布病)与弥漫性大B细胞淋巴瘤(DLBCL)的临床特征、诊断和鉴别诊断方法以及两种疾病可能的关系,提高临床医师对两种疾病的认识。方法 采用查阅病历等方式获取2023年山东省潍坊市1例布病合并DLBCL患者临床、流行病学信息,采集血液样本进行血清试管凝集试验、血培养等实验室检查,进行脊椎磁共振成像、眼眶计算机断层扫描等影像学检查,以及骨髓穿刺病理检查等。结果 病例为青年男性,经常接触生羊肉,临床症状以腰痛及关节疼痛为主,化验血清试管凝集试验阳性,血培养见布鲁氏菌生长,骨髓病理免疫组化提示DLBCL,给予规范抗布病、免疫化疗及骨髓移植术等治疗,效果不佳,最终死于骨髓移植后严重感染。结论 布病并发DLBCL的情况较为罕见,但仍需引起临床医师的高度重视。在诊断过程中,应注意对患者进行全面的检查和评估,以排除其他可能的疾病。

Objective To understand the clinical characteristics,diagnostic and differential diagnostic methods of brucellosis and diffuse large B-cell lymphoma(DLBCL),the possible relationship between the two diseases and improve the understanding of clinical physicians about the two diseases.Methods Clinical and epidemiological information of a brucellosis case complicated with DLBCL in Weifang were collected from the medical records,and blood samples were collected from the case for laboratory examinations,such as serum agglutination test and blood culture.Imaging examinations,such as spinal magnetic resonance imaging and orbital computed tomography,were performed,and the pathological analysis on the bone marrow aspirate was performed.Results The case was a young man who had frequent contacts with raw lambs.The main clinical manifestations of the case were lower back pain and joint pain.The serum agglutination test for Brucella was positive,and Brucella was isolated from blood culture.Bone marrow pathology and immunohistochemistry suggested DLBCL.The case received standardized anti-brucellosis treatment,immunochemotherapy,and bone marrow transplantation,but he died of severe infection after bone marrow transplantation eventually.Conclusion Brucellosis complicated with DLBCL is rare,but it still needs attention by clinical physicians.During the diagnostic process,it is necessary to conduct comprehensive examination and evaluation to exclude other possible diseases.