第485例--不明原因发热,低氧血症

患者男,49岁,因“发热半年余”就诊。患者在当地医院诊断为“干燥综合征”,予泼尼松60 mg/d口服治疗后热退,但泼尼松减量至40 mg/d后再次发热。入院后因发现血培养及便培养示肠炎沙门菌阳性,先后予头孢他啶、头孢曲松、亚胺培南-西司他丁抗感染治疗共4周,但体温仍未控制。患者虽无呼吸系统症状及体征,且胸部高分辨CT未见明显异常,但检查发现动脉血氧分压降低,乳酸脱氢酶及β2微球蛋白显著升高,肺功能检查显示弥散功能减低,正电子发射计算机体层显像(PET)/CT见双肺弥漫性代谢增高,最终通过支气管镜下肺活检诊断肺血管内大B细胞淋巴瘤(IVLBCL)。

The 485th case:fever of undetermined origin and hypoxemia

A 49-year-old male was admitted to Peking Union Medical College Hospital presented with fever for more than half a year.The patient was diagnosed as Sjogren′s syndrome at local hospital.After oral prednisone 60 mg per day was given,the fever alleviated,but recurred after prednisone tapered to 40 mg/d.Both blood culture and stool culture were positive for Salmonella enteritidis.Antibiotics including ceftazidime,ceftriaxone,cilastatin-imipenem were sequentially administrated for 4 weeks,yet not effective.Although there were not respiratory symptoms or certain abnormalities on high-resolution chest CT,arterial blood gas indicated hypoxemia.Serum lactate dehydrogenase andβ2 micro-globulin were elevated,and the lung function test demonstrated significant impairment of diffusion function.Positron emission tomography-computed tomography(PET/CT)scan suggested that high fluorodeoxyglucose uptake was diffusely seen in both lungs.The patient was finally diagnosed as pulmonary intravascular large B-cell lymphoma(IVLBCL)by transbronchial lung biopsy.This case aims to emphasize the differentiation diagnoses of pulmonary intravascular lymphoma from common situations.