急性白血病在急诊中的误漏诊3例分析

在急诊工作中将急性白血病误诊为其它疾病的病例屡见不鲜,现将我院急诊中误漏诊的急性白血病3例报告如下。一、以宫外孕、左侧卵巢囊肿收住妇科例1、女,30岁。因发烧伴左下腹疼痛7天于1989年5月18日入院。查体:体温39℃,贫血面容。左下腹压痛、反跳痛及肌紧张。宫体大小正常,左侧卵巢处可触及5×6cm包块,压痛,后穹窿穿刺液检查:红细胞++++、白细胞+。B型超声波提示“宫外孕”。入院后经输血、抗生素等治疗两天,下腹疼痛好转,因严重贫血(Hb36g/L),全身皮肤紫癜和血片中有幼稚粒细胞,经骨髓象检查确诊为:急性粒细胞性白血病。二、以左下腹外伤并腹膜炎、败血症收住外科例2 男,22岁。因左下腹外伤半月,发烧7     

吡喹酮治疗全结肠直肠血吸虫肉芽肿一例报告

我站於1986年6月收治全结肠、直肠血吸虫肉芽肿病1例,服吡喹酮治疗后,疗效满意,现报告如下: 患者柳××、男、 36岁、已婚,渔民。因左下腹索状包块,近4个月中下腹不定位隐痛,大便伴粘液血冻、纳差、消瘦、乏力入院。     

伴有大量腹水的多中心型Castleman病1例

正Castleman病是一种以弥漫性淋巴结肿大、脾肿大、贫血、血小板增多、高球蛋白血症、血清炎性因子升高和全身炎症反应为特征的淋巴增殖性疾病。其临床表现缺乏特异性,需完全根据病理学改变方可确诊。本文报道1例伴有大量腹水的多中心型Castleman病的临床特点及诊疗策略,并进行了鉴别诊断的相关分析,为Castleman病的诊断提供线索。在临床工作中,当患者出现全身性淋巴结肿大伴大量浆膜腔     

一例双子宫双阴道、左侧阴道部分闭锁误诊经过

患者27岁,已婚。自1981年阴道流脓样白带伴左下腹及阴道坠痛,经期加重,有时发烧、尿频。曾到多处医院就诊,按“阴道炎”治疗无效。1981年3月在某医院检查发现左侧盆腔有一包块,宫颈口流脓液,诊为“盆腔脓肿自破”,经阴道左侧壁行“脓肿     

含左氧氟沙星方案治疗盆腔结核性包块69例临床分析

左氧氟沙星是抗菌作用较强、抗菌谱较广的氟喹诺酮类药物,基础和临床研究均已证明,该药具有较强的抗分枝杆菌活性。近年来,国内外含左氧氟沙星方案治疗肺结核病的报道已屡见不鲜,但用于女性盆腔结核包块的治疗未见报道。为评价其治疗女性盆腔结核包块的有效性和安全性,自1998年9月～2006年12月,我们以经开腹活检确诊的女性盆腔结核包块,因粘连较重,无法行病灶切除者69例为研究对象,进行此项研究。     

溶血病

0272 自身免疫性溶血性贫血伴球形红细胞增多症一例报告黄子洲等中华血液学杂志1(6);361,1980 文中报道自身免疫性溶血性贫血伴球形红细胞增多症一例。其临床特征是:①脾脏显著肿大(左锁骨中线下10厘米),②贫血,③末梢血片出现球形红细胞,骨髓象有核细胞增生明显活跃,④Coob's试验,常规方法反复试验(一),改用标准抗IgG或IgM血清而获得阳性。使患者得到确诊。     

化脓性阑尾炎致腹壁脓肿1例

患者男,38岁。因右下腹隐痛半月伴包块10天入院。半月前患者因进食冷食物后感右下腹隐痛,伴腹泻,发烧,经抗炎输液效果欠佳;10天前右下腹扪及一核桃大小包块,渐增大伴疼痛,体温37.6～38.5℃。查体:体温38℃,右下腹局限性隆起,     

结肠重复畸形合并肾积水1例报告

患者女,45岁。因左腰背部间断胀痛伴左下腹坠胀感、大便不规律1 a,于2011年7月26日入院。查体:左下腹部可触及条索状包块,大小约4.0 cm×7.0 cm,界限欠清,质硬,活动度可,无压痛。左腰背部肾区偏外侧可见一凹陷性瘢痕(自诉30余年前,左腰背部皮下肿块伴皮肤破溃流脓,于当地卫生院行手术治疗,具体不详)。余查体无异常。B超示左肾积水;静脉肾盂造影左肾未显影;双肾CT检查     

Kimura病1例并文献复习

目的提高对少见疾病Kimura病的认识。方法分析广州医学院第一附属医院广州呼吸疾病研究所于2008年7月29日收治的1例Kimura病伴支气管扩张患者的临床和病理资料,并复习相关文献。结果患者,女,18岁,16年前接种卡介苗后反复咳嗽、咳痰、出现全身多发性包块,临床特征主要是血嗜酸性淋巴细胞增多、头颈部包块及淋巴结肿大和支气管扩张。颈部皮下肿物活检符合嗜酸性淋巴肉芽肿,对糖皮质激素治疗有效。结论Kimura病属于少见病,合并支气管扩张是首例报道。     

腹腔医源性异物感染致降结肠穿孔一例

患者女性,26岁,因左下腹痛伴发热15 d入院.患者于50 d前在当地某医院行剖官产手术,术中顺利.术后1个月余出现左下腹隐痛,伴高热,在当地抗感染治疗症状无好转入我院.患者食欲差,大小便正常.查体:体温39.5℃,血压16/10 kPa.下腹有一长12 cm横形手术瘢痕,腹软,左下腹触及一12 cm×10 cm包块,质软,有触痛,活动度可.     

Polyclonal lymphadenopathy presenting as plasma cell leukemia with reversible renal insufficiency

A case is reported of an elderly patient with generalized lymphadenopathy who, at presentation, showed a blood and bone marrow picture suggestive of plasma cell leukemia, polyclonal hypergammaglobulinemia restricted almost exclusively to IgA, and severe renal insufficiency. Treatment with melphalan and prednisone produced a complete remission that lasted only 1 month. A second partial remission was obtained, but the patient eventually died of heart failure. The pathological picture of the lymph nodes and spleen was intermediate between that of angioimmunoblastic lymphadenopathy (AIL) and of the plasma cell type of giant lymph node hyperplasia (Castleman's disease). The hypothesis is presented that AIL, Castleman's disease and many other polyclonal lymphadenopathies recently described in immunodeficient or elderly patients, including the present case, represent a continuous spectrum of lymphoproliferative disorders due to abnormal responses to various stimuli.     

A benign course of multicentric Castleman's disease with involvement of the spleen and bone marrow

The multicentric variant of Castleman's disease (MCCD) is associated with a rapidly progressive and fatal course. The case described herein manifested unique clinical and histological features. Initial presentation as isolated splenomegaly was subsequently followed by widespread organ involvement, including lymph nodes and bone marrow. In spite of this, the patient had a very benign course of her disease. The case serves to expand even further the already wide clinical spectrum of Castleman's disease.     

A case of Castleman's disease mimicking a hepatocellular carcinoma: a case report and review of literature

Castleman's disease is a rare disease characterized by lymph node hyperplasia. Although Castleman's disease can occur wherever lymphoid tissue is found, it rarely appears in the abdominal cavity, and is especially rare adjacent to the liver. Here, we report a rare case of Castleman's disease in the portal area that mimicked a hepatocellular carcinoma (HCC) in a chronic hepatitis B patient. A 40 year-old woman with chronic hepatitis B presented with right upper quadrant discomfort. Computed tomography and magnetic resonance imaging results showed a 2.2 cm-sized, exophytic hypervascular mass in the portal area. HCC was suspected. However, histologic examination revealed Castleman's disease. We suggest that Castleman's disease should be included as a rare differential diagnosis of a hypervascular mass in the portal area, even in patients with chronic hepatitis B.     

Trigeminal neuropathy in a case of mesenteric localized Castleman's disease.

Peripheral neuropathy of the limbs has so far been observed in very few patients with localized Castleman's disease, generally of the plasma-cell type. In the present case report, of a plasmacellular type localized within the mesenterium, a 25-year-old woman exhibited a clinical picture of right trigeminal neuropathy (together with more common constitutional symptoms and laboratory findings), which promptly disappeared after surgical removal of the mesenteric mass. To our knowledge, a similar impairment of cranial nerves, and specifically of the trigeminal, has never been reported in patients with the localized form of Castleman's disease.     

Pathogenic significance of interleukin-6 (IL-6/BSF-2) in Castleman's disease

Castleman's disease is a syndrome consisting of giant lymph node hyperplasia with plasma cell infiltration, fever, anemia, hypergammaglobulinemia, and an increase in the plasma level of acute phase proteins. It has been reported that clinical abnormalities disappear after the resection of the affected lymph nodes, suggesting that products of lymph nodes may cause such clinical abnormalities. Interleukin-6 (IL-6) is a cytokine inducing B-cell differentiation to immunoglobulin-producing cells and regulating biosynthesis of acute phase proteins. This report demonstrates that the germinal centers of hyperplastic lymph nodes of patients with Castleman's disease produce large quantities of IL-6 without any significant production of other cytokines. In a patient with a solitary hyperplastic lymph node, clinical improvement and decrease in serum IL-6 were observed following surgical removal of the involved lymph node. There was a correlation between serum IL-6 level, lymph node hyperplasia, hypergammaglobulinemia, increased level of acute phase proteins, and clinical abnormalities. The findings in this report indicate that the generation of IL-6 by B cells in germinal centers of hyperplastic lymph nodes of Castleman's disease may be the key element responsible for the variety of clinical symptoms in this disease.     

Hodgkin's and Castleman's disease in a patient with systemic mastocytosis

 Systemic mastocytosis is a rare condition characterized clinically by the local consequences of vasoactive peptides released from infiltrating mast cells in the reticuloendothelial tissues. Mast cells originate from the pluripotent bone marrow stem cells; it is therefore not surprising that myeloproliferative and myelodysplastic disorders commonly coexist or terminate the clinical phase of mastocytosis. We report here, to our knowledge, the first case of Hodgkin's and Castleman's disease occurring in a patient with co-existent systemic mastocytosis, which remained unchanged after combination chemotherapy for Hodgkin's disease. Received: December 18, 1997 / Accepted: September 8, 1998     

Localized Castleman's disease: description of a case and review of the literature

Castleman's disease is a rare entity which is caracterized by its histological features: hyperplasia of lymph nodes and capillary proliferation. Two histological patterns has been described: hyaline vascular type and plasma cell type. From a clinical viewpoint has been identified two different clinical course: a localized type (ECL) usually of benign clinical course and a multicentric type (ECM) of worst prognosis. We present a case of Castleman"s disease localized in the neck region in which the excision was both diagnostic and therapeutic. The variety histological was hyaline-vascular type.     

Graft versus host disease after orthotopic liver transplantation documented by analysis of short tandem repeat polymorphisms

We report a case of graft versus host disease after liver transplantation in which the diagnosis was made by short tandem repeat analysis. A retrospective analysis using a bone marrow sample showed the presence of chimerism already at a time when the characteristic full clinical picture of graft versus host disease had not yet developed, opening the way for the early diagnosis and treatment.     

Interleukin-6-producing thymic squamous cell carcinoma associated with Castleman's disease and nephrotic syndrome

When a 63-year-old man was hospitalized with nephrotic syndrome due to focal segmental glomerulosclerosis, a mediastinal mass was discovered. A biopsy specimen obtained by mediastinoscopy showed findings compatible with the plasma cell type of Castleman's disease. Fever, anemia, and anti-nuclear antibody were present. Serum concentrations of gamma globulin, acute phase proteins, and, most strikingly, interleukin-6 (IL-6) were elevated. Methylprednisolone pulse therapy resulted in no clinical improvement. Pathologic examination of the resected thymic tumor showed a squamous cell carcinoma immunoreactive for IL-6. To our knowledge, this case represents the first reported IL-6-producing thymic squamous cell carcinoma associated with Castleman's disease and nephrotic syndrome.     

Successful treatment of Castleman's disease with HAART in two HIV-infected patients

Castleman's disease is a heterogeneous group of lymphoproliferative disorders of unknown aetiology. Recently, human herpesvirus type 8 (HHV-8) has been associated with various diseases in individuals with HIV infection, including Kaposi's sarcoma, B cell non Hodgkin's lymphomas, and Castleman's disease.In Castleman's disease it has been hypothesized that HHV-8, encoding a number of various virokines, can be responsible for clinical manifestations of the disease.Previously, two reports have described a clinical recovery from HIV-associated Castleman's disease: by administration of a monoclonal antibody neutralizing human IL-6 in one case, and in another case by treatment with highly antiretroviral therapy and anti-herpesvirus therapy, following splenectomy. We report two cases where HAART alone led to clinical recovery from Castleman's disease.In both the cases reported here, although follow-up biopsy was not performed, it is likely that the inhibition of HHV-8 replication and of virokine release, through the restoration of immunity by HAART, was the basis for the disappearance of the clinical symptoms.