系统性红斑狼疮的表现:弥漫的淋巴结肿大
翻译人:李变变 校对人:梁美娥 审核者:张莉芸
Diffuse lymphadenopathy as the presenting manifestation of systemic lupus erythematosus
Abstract We report the case of a 27-year-old African American man who presented with 6 months of generalized lymphadenopathy and nothing in his history or examination to suggest systemic lupus erythematosus (SLE). He was thought to have lymphoma, syphilis, or tuberculosis, and an extensive workup was done. Laboratory investigation finally revealed leukopenia (4.0), proteinuria (1.87 g), antinuclear antibodies (640 speckled), anti-double-stranded DNA (640), anticardiolipin immunoglobulins G and M, anti-Smith, Coombs, anti-Ro, anti-La, CK (531 U/L), aldolase (8.5 U/L), high erythrocyte sedimentation rate (130 mm/h), and low complement (C3 15 mg/dL and C4 3 mg/dL). A kidney biopsy showed diffuse proliferative glomerulonephritis, International Society of Nephrology class IV. Generalized lymphadenopathy as the first and only manifestation for 6 months made the diagnosis of SLE challenging. Generalized diffuse lymphadenopathy has been associated with SLE but is much lessfrequent now than in the past. The differential diagnosis of lymphadenopathy relevant to rheumatologists includes Kikuchi histiocytic necrotizinglymphadenitis, Castleman disease, syphilis, tuberculosis, sarcoidosis, and lymphoma
摘要 病例报道:一27岁非洲裔美国男子,全身弥漫淋巴结肿大6月,既往体健(无任何检查证实SLE)。该病人被怀疑患有淋巴瘤、梅毒或肺结核。完成大量检查后证实SLE:白细胞减少(4.0)、蛋白尿(1.87g)、抗核抗体(640斑点型)、抗双链DNA抗体(640)、抗磷脂IgG IgM 、抗Smith、Coombs、抗-Ro、抗-La、CK(531U/L),醛缩酶(8.5U/L),血沉(130mm/h),低补体(C3 15mg/dL C43mg/dL)。肾脏活检结果示弥漫增生性肾小球肾炎,国际肾脏病学会IV级,持续6个月的全身淋巴结肿大首次作为且唯一的体征,使SLE诊断较为棘手。全身淋巴结肿大与SLE相关但在过去发生几率是很小的,风湿科医师需鉴别的相关诊断包括组织细胞坏死性淋巴腺炎、巨大淋巴细胞增生病、梅毒、肺结核、结节病、淋巴瘤。