Rituximab-induced interstitial lung disease: case report and literature review

Rituximab, a chimeric monoclonal antibody against CD20, very rarely causes lung toxicity. Toxicity may present as interstitial lung disease, alveolar hemorrhage and adult respiratory distress syndrome. Sixteen cases of rituximab-induced interstitial lung disease (R-ILD) have been reported. With this case and a review of all other cases reported in the literature, we will try to identify the features of R-ILD, its treatment and why the early diagnosis of this complication is important.     

Successful treatment of erlotinib-induced acute hepatitis and acute interstitial pneumonitis with high-dose corticosteroid: a case report and literature review

Erlotinib, a kind of epidermal growth factor receptor tyrosine kinase inhibitor, is a target therapy and approved for the treatment of metastatic non-small cell lung cancer (NSCLC) and advanced pancreatic cancer. Among these EGFR-TKI agents, including gefitinib and erlotinib, the common dose-limiting toxicities are diarrhea, mucositis and skin rash (Acneform eruptions). In addition to the above adverse effects, infrequent but potentially fatal and lethal entity complications include acute interstitial lung disease (ILD) and acute hepatitis. The incidence of EGFR-TKI agents (gefitinib and erlotinib) induced acute hepatitis is rare and hepatotoxicity of EGFR-TKI agent was rarely discussed. The treatment of EGFR-TKI agents induced acute hepatitis remains uncertain and cessation medication is current policy. Here we reported a case of erlotinib induced interstitial pneumonitis and acute hepatitis with clinical appearance of hypoxemia and general weakness, treated with high dose pulse therapy and showed good recovery.     

Successful treatment of gallbladder neuroendocrine carcinoma with combined chemo-radiotherapy: a case report and literature review

Neuroendocrine tumors (NETs) occur in the bronchopulmonary system. Extrapulmonary NETs are rare and are considered to ac count for 2.5 - 5% of all NETs, with more than 60% of these tumors occurring along the gastro intestinal tract, including primary NET of the gall bladder. Pri mary NETs of the gall bladder have been classified as carcinoid, neuroendocrine carcinoma or heterogeneous carcinoma. Currently, the main treatment of neuroendocrine car ci noma re mains surgery. The role of radiotherapy and chemotherapy is undefined be cause of the paucity of data. In advanced cases, chemotherapy has been prescribed with such effective agents as cisplatin, carboplatin, etoposide and paclitaxel. Here we re port a case of a 64-year-old Taiwanese male patient with neuroendocrine carcinoma of the gall bladder who received combined chemoradiotherapy (CCRT) with cisplatin, 5- fluorouracil and leucovorin (PFL) from June 2009 un til now, and whose disease is stable. CCRT with PFL may be a possible reg i men for high-grade neuroendocrine carcinoma of the gall bladder.     

厄洛替尼引起急性间质性肺病死亡2例

2例男性肺癌患者口服厄洛替尼发生间质性肺病死亡。病例1,1名84岁男性肺腺癌并骨转移患者,因骨痛给予厄洛替尼150mg,1次/d口服。用药当晚患者开始发热,T38.3℃,伴咳嗽、咳痰,但骨痛有所减轻。给予头孢曲松钠抗感染治疗,体温恢复正常,病情逐渐恶化。服药11d后出现呼吸困难,在吸氧5L/min的情况下动脉血氧分压67.5mmHg,X线胸片示:双肺弥漫性间质病变,停用厄洛替尼。次日死于呼吸衰竭。病例2,1名69岁男性,因右肺鳞癌经化疗、放疗和对症治疗后,CT显示病灶稍有缩小,病情稳定。服用厄洛替尼150mg,1次/d。2d后,出现面部及躯干部皮疹,局部对症治疗后好转。服药29d后出现发热,咳嗽、气短加重,血常规:WBC10.2×109/L,抗感染治疗效果不明显。服药35d复查CT示双肺弥漫性间质病变,停厄洛替尼。次日病情急剧恶化,出现严重呼吸困难,动脉血气示低氧血症,第3天死于呼吸衰竭。     

Acute hemolysis after receiving oxaliplatin treatment: a case report and literature review

Objective To report a case of immune mediated hemolysis occurring after oxaliplatin infusion in a patient with rectal cancer. Case summary We report a 69 year old male patient who presented with acute onset anemia after infusion of oxaliplatin as chemotherapy. A positive direct Coombs test and good response to steroids treatment underlined the diagnosis of immune related hemolytic anemia. The patient was switched to irinotecan-based chemotherapy regimen for further treatment. Discussion To our knowledge, there has been less than 10 cases of hemolysis occurring after oxaliplatin treatment in the medical literature. In all cases, immune mediated hemolysis has been proven with a positive coombs test. As oxaliplatin based chemotherapy regimen has become a standardized first line treatment for metastatic colorectal adenocarcinoma, this phenomenon warrants a higher level of physician awareness. Conclusions Oxaliplatin related hemolytic anemia is a rare reported phenomenon. Patient under oxaliplatin treatment presenting with sudden hemoglobin decrease should prompt further investigation of hemolysis.     

合并甲状腺病变的嗜酸性筋膜炎1例及文献复习

目的 报告1例合并甲状腺病变的嗜酸性筋膜炎(EF)病例，为今后临床诊治提供参考。方法 兰州大学第二医院2021年4月2日收治的1例合并甲状腺疾病的女性EF病例，对相关文献进行复习。结果 女，52岁。双肩关节皮肤肿痛2月，双前臂皮肤肿胀、僵硬1月，入院检查时发现甲状腺结节。双前臂“沟槽征”，双前臂核磁共振成像示筋膜炎症性改变，外周血嗜酸性粒细胞计数0.55×109/L。甲状腺组织病理活检提示甲状腺乳头状癌、结节性甲状腺肿、桥本甲状腺炎。综上诊断为EF、甲状腺恶性肿瘤(乳头状癌)、桥本甲状腺炎、结节性甲状腺肿。给予醋酸泼尼松片和甲氨蝶呤，3月后皮损基本痊愈；并行双侧甲状腺切除+左侧中央区清扫，随访3月无复发及转移。结论 EF可能作为系统性疾病的皮肤表现，遇到此类病人除积极筛查自身免疫系统、血液系统相关疾病等常见合并症，也应该高度警惕实体肿瘤等少见合并症，早期识别各种潜在疾病。     

右肺术后切口出现侵袭性纤维瘤1例及文献回顾

侵袭性纤维瘤病,在临床上发病率很低,是一种低度恶性来源于间叶组织的肿瘤。该疾病大约50%以上发生在腹部,四肢和深部软组织的发病率次之 ［1］。目前病因尚不清楚。Gurbuz等 ［2］认为,10%～20%的患者在患有侵袭性纤维瘤病的同时也患有家族性腺瘤性息肉病（familial adenomatous...     

临床无肌病性皮肌炎合并快速进展间质性肺疾病患者 铁蛋白与疾病活动度二例报告及文献复习

摘要：目的 通过分析2例临床无肌病性皮肌炎（CADM）合并快速进展间质性肺疾病（RP-ILD）死亡病例的临床 资料,总结诊治经验。方法 对2015年1月—2018年1月2例CADM合并RP-ILD死亡病例的临床表现、实验室及影 像学检查、诊断及治疗进行回顾性分析,总结其临床特点、治疗方案及死亡原因。结果 2例CADM合并RP-ILD死 亡病例抗黑素瘤分化相关基因5（MDA5）抗体结果均阳性,入院时2例患者的SF水平均有明显升高,但胸部CT仅提 示散在炎症。随着患者的呼吸情况逐渐加重,SF水平进行性升高,胸部影像学表现进展,给予激素、他克莫司及环磷 酰胺3种药物的联合治疗,2例患者分别于发病66 d、61 d因呼吸衰竭而死亡。结论 高SF水平反映了抗MDA5抗体 相关的DM患者ILD的病情恶化。在判断疾病的进展方面,SF水平比胸部CT检查具有更早的诊断价值。     

加巴喷丁治疗小脑梗死后慢性呕吐1例及文献回顾

目的 探讨加巴喷丁在治疗慢性恶心呕吐中的作用.方法 对1例自2019年5—12月以头晕、恶心、呕吐为首发症状的小脑梗死病人的病程、临床表现、辅助检查及治疗经过进行分析.本研究经病人及其近亲属知情同意,符合《世界医学协会赫尔辛基宣言》相关要求.结果 以头晕、恶心、呕吐为首发症状的小脑梗死,可无神经系统定位体征,易误诊、漏...     

索拉非尼诱发高胆红素血症个案报道并肝功能障碍的文献统计分析

目的:通过病例报告及文献分析探讨索拉非尼诱发的肝脏系统不良反应.方法:报告1例索拉非尼致患者胆红素升高的不良反应,检索国内外相关文献,汇总后进行文献统计分析.结果:包括本文报告的索拉非尼诱发胆红素升高的病例,共有16篇文献(17个病例)纳入研究.17个病例中男性15名,女性2名,患者年龄为47～77岁(平均年龄63岁)...     

奥司他韦致结膜炎1例及文献复习

奥司他韦(oseltamivir)是一种神经氨酸酶抑制剂,通过抑制病毒从被感染细胞中释放,从而减少甲型或乙型流感病毒的播散,用于治疗成人和1岁以上儿童的甲型和乙型流感,以及用于预防成人和13岁及以上青少年的甲型和乙型流感[1].奥司他韦常见的不良反应主要有胃肠系统损害(呕吐、恶心、腹泻、腹痛)、神经系统紊乱(睡眠障碍、...     

Shprintzen-Goldberg综合征1例报道并文献复习

目的　总结Shprintzen-Goldberg综合征的临床特点,提高对此病的认识。方法　总结深圳市儿童医院诊断的1例Shprintzen-Goldberg综合征临床资料,并查阅相关文献。结果　患儿,男,G2P2,足月顺产,无神经系统疾病家族史。孕产期正常,出生后肌张力低,目前运动发育落后,1岁,不会抬头,不会坐,不会爬,无抽搐。查体：特殊面容,长头畸形,前额突出,眼距增宽,浅眼眶,上腭狭窄,高颚弓,小下颌,心肺听诊未见异常,腹部查体未见异常,手指和脚趾细长。辅助检查：头颅MRI示双侧侧脑室增宽,略变形,以左侧侧脑室前角较显著,双侧脑室室管膜下囊肿,颅颈交界区枕骨大孔及下方椎管狭窄,椎管前后径约5 mm,颈髓呈受压表现。头颅CT提示颅缝早闭。心脏彩超提示房间隔左向右分流,大小约0.37 cm。染色体核型正常：46XY。全外显子测序提示：SKI基因c.100G>C突变,为错义突变。父母基因正常,为新发突变。根据美国医学遗传学与基因组学学会（ACMG）指南,该变异初步判定为致病性变异。查阅文献,患儿符合Shprintzen-Goldberg综合征的临床表现,基因相符,突变位点既往未报道过,但该突变位点在基因的功能区,结合蛋白功能预测软件,考虑为致病变异,加上临床表现,考虑该诊断。此疾病在中文文献未见详细的报道,为常染色体显性遗传病。主要表现为外貌的发育异常,可合并多系统的损害,表现为智力低下,颅缝早闭,四肢细长为主,类似马凡综合征。治疗以对症支持为主。结论　发育落后+颅缝早闭+类似马凡综合征表现应该考虑Shprintzen-Goldberg综合征可能,及时颅骨三维CT检查及完善基因检测明确诊断,早期干预改善预后。     

椎基底动脉扩张延长症一例并文献复习

椎基底动脉扩张延长症（VBD）是由先天发育、后天获得性因素或两种因素共同作用于椎动脉颅内段和 （或）基底动脉，致其显著扩张、延长、迂曲、成角移位，或压迫周围神经或组织所引起的临床症状，为一种少见且病因 不清的脑血管变异病。本文报告收治的1例频发头晕，主要临床表现为后循环梗死，以小脑、延髓为主，经严格检查 后诊断为VBD的病例诊治情况，并进行相关文献复习。     

Successful treatment with duloxetine in a case of treatment refractory bulimia nervosa: a case report

The authors report a case of treatment refractory bulimia nervosa successfully treated with duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, with complete remission of the patient's bingeing and purging behaviours. This case is discussed in the context of existing literature on the psychopharmacology of bulimia nervosa.     

胰岛素瘤一例并文献复习

目的 总结分析胰岛素瘤的临床特点,探讨其诊断治疗方法.方法 对我院收治的1例胰岛素瘤患者的临床资料进行回顾性研究,并结合国内外有关文献报道进行分析.结果 该例胰岛素瘤患者有典型的Whipple三联征.血糖1.9～3.6 mmol/L,胰岛素释放指数＞0.3;腹部超声检查示胰腺区低回声结节,腹部CT检查示胰腺占位;剖腹探查结合B型超声检查示胰腺体部有直径约2.1 cm×1.0 cm结节.结论 典型的临床表现、B超及CT薄层扫描结合胰岛素水平测定是诊断胰岛素瘤的有效方法,外科手术切除肿瘤是治疗的有效手段.     

钝性肾损伤后肾动脉假性动脉瘤1例报道并文献复习

目的　探讨钝性肾损伤后肾动脉假性动脉瘤（RAP）的临床特点及治疗方案。方法　回顾性分析2021年12月解放军第九〇三医院诊治的1例和筛选1996—2021年期间文献报道且资料较齐全的35例钝性肾损伤后RAP患者的临床资料。全组男28例，女7例，1例未报道性别；年龄（27.0±14.4）岁。报道RAP发病时间32例，诊断时间（14.0±12.5）d。统计学方法采用独立样本t检验。结果　RAP多在钝性肾损伤后14 d左右形成，最常见临床表现为肉眼血尿和腰腹痛。36例患者中31例行超选择性动脉栓塞术，5例保守治疗。除保守治疗的1例有RAP残留外，余均痊愈。保守治疗后痊愈的4例和选择动脉栓塞术治疗的31例二者间的瘤体最大径［（7.5±3.1）mm比（15.7±6.2）mm］比较差异有统计学意义（P=0.022）。结论　钝性肾损伤后出现迟发性肉眼血尿或突发腰腹部疼痛应考虑RAP。增强CT和多普勒超声推荐作为首选检查，数字减影血管造影（DSA）是诊断的“金标准”。超选择性动脉栓塞术为一线治疗方案，截至目前保守治疗缺乏高等级证据支持，但在RAP最大径≤10 mm的无症状患者中可考虑选择。     

直肠癌术后播散性浅表性汗孔角化症一例并文献复习

播散性浅表性汗孔角化症(DSP)是汗孔角化症(PK)的一种类型,属于一种少见的慢性进行性皮肤角化不全性皮肤病,男女均可见.该病是常染色体显性遗传病,但也存在部分散发病例.DSP的治疗目前没有系统的指南,治疗方式大多以病例报道的方式呈现.笔者诊治1例直肠癌术后的播散性浅表性汗孔角化症患者,给予云芝菌胶囊口服、丙酸氟替卡松...