Walls J, Dessypris E N, Krantz S B
Department of Medicine, Veterans Affairs Medical Center, Nashville, Tennessee.
Am J Med Sci. 1992 Dec;304(6):363-5. doi: 10.1097/00000441-199212000-00007.
Large granular lymphocytosis (LGL) is characterized by enhanced proliferation of T lymphocytes that have antibody-dependent cell-mediated cytotoxicity or natural killer cell activity and that often produce severe cytopenias, including neutropenia. When a 68-year-old man with seropositive rheumatoid arthritis and severe neutropenia was examined, he was found to have LGL with a T cell gene rearrangement, indicating the presence of a clonal population of T lymphocytes. The patient was admitted with a fever of 102 degrees F and a nonhealing ulcer over the right tibia. When the infection did not respond to intravenous antibiotics, granulocyte colony-stimulating factor (GCSF) therapy was started at 5 micrograms/kg subcutaneously each day. The neutrophil count promptly increased and the patient subsequently defervesced and was able to have a skin graft placed, which healed without difficulty. GCSF, which is known to be an effective therapeutic agent for neutropenia associated with chemotherapy and bone marrow transplantation, also was a very valuable treatment for the life-threatening neutropenia of LGL.
大颗粒淋巴细胞增多症（LGL）的特征是具有抗体依赖性细胞介导的细胞毒性或自然杀伤细胞活性的T淋巴细胞增殖增强，且常导致严重的血细胞减少，包括中性粒细胞减少。在对一名68岁血清反应阳性类风湿性关节炎且严重中性粒细胞减少的男性进行检查时，发现他患有T细胞基因重排的LGL，表明存在T淋巴细胞克隆群体。该患者因体温102华氏度及右胫骨处不愈合溃疡入院。当感染对静脉用抗生素无反应时，开始每天皮下注射5微克/千克的粒细胞集落刺激因子（GCSF）治疗。中性粒细胞计数迅速增加，患者随后退热，并能够进行皮肤移植，移植顺利愈合。GCSF已知是化疗和骨髓移植相关中性粒细胞减少的有效治疗药物，对于LGL危及生命的中性粒细胞减少也是非常有价值的治疗方法。
