Taura Y, Yamazaki H, Katou T
Department of Internal Medicine, Kokura Memorial Hospital.
Nihon Kokyuki Gakkai Zasshi. 2000 Jan;38(1):34-8.
Patient 1 was a 71-year-old man who had been admitted to our hospital with high-grade fever. Chest computed tomographic (CT) images revealed clear peripheral and high-density central areas. Abnormal laboratory findings included elevated LDH and hypoxemia. Interstitial pneumonia was suspected, and transbronchial lung biopsy (TBLB) confirmed the diagnosis of intravascular lymphomatosis (IVL). The patient succumbed before completion of chemotherapy. Patient 2 was a 65-year-old man admitted with high-grade fever. Abnormal laboratory findings included pancytopenia, hypoxemia, and elevated levels of LDH and soluble interleukin-2 receptor. Chest CT images revealed diffuse, mildly dense areas in the upper fields of both lungs. TBLB specimens yielded a diagnosis of IVL. Complete clinical remission was obtained with CHOP multiagent chemotherapy. Although IVL is usually diagnosed at autopsy, in these 2 cases an antemortem diagnosis was made on the basis of TBLB findings. Also, multiagent chemotherapy achieved a complete clinical remission in Patient 2.
患者1是一名71岁男性，因高热入院。胸部计算机断层扫描（CT）图像显示外周清晰而中央高密度区域。实验室检查异常包括乳酸脱氢酶（LDH）升高和低氧血症。怀疑为间质性肺炎，经支气管肺活检（TBLB）确诊为血管内淋巴瘤（IVL）。患者在化疗完成前死亡。患者2是一名65岁男性，因高热入院。实验室检查异常包括全血细胞减少、低氧血症以及LDH和可溶性白细胞介素-2受体水平升高。胸部CT图像显示双肺上叶弥漫性轻度致密区域。TBLB标本诊断为IVL。采用CHOP联合化疗实现了完全临床缓解。尽管IVL通常在尸检时确诊，但在这2例中根据TBLB结果做出了生前诊断。此外，联合化疗使患者2实现了完全临床缓解。
