Arai N, Hara A, Umeda M, Sirai T
First Department of Internal Medicine, Toho University of Medicine, Tokyo.
Rinsho Ketsueki. 1992 Sep;33(9):1252-6.
A 73-year-old man was admitted to our hospital on April 30, 1990, because of fever persisting for 18 months. Bone marrow puncture and biopsy were performed, because examination on admission revealed an elevated leukocyte count and anemia while his superficial lymph nodes, liver and spleen were not palpable. The results of the bone marrow biopsy revealed evidence of granuloma. Around May 10, the patient developed hepatosplenomegaly and enlargement of left cervical lymph nodes. Based on the results lymph node biopsy, a diagnosis of Hodgkin's disease was made, and CHOP therapy was instituted on May 20. However, the patient developed interstitial pneumonia and died on July 3. This patient's disease was manifested by fever of unknown origin. Bone marrow biopsy revealed granuloma with histiocytes predominating, and the patient subsequently developed lymph node enlargement. His disease was then diagnosed as Hodgkin's disease on the basis of a biopsy. Malignant lymphomas associated with granulomas in the bone marrow, liver or spleen are for the most part found in the advanced stage of the disease. It should be borne in mind, however, that some patients may exhibit granuloma formation in their bone marrow prior to lymph node enlargement or hepatosplenomegaly, as in the present case.
一名73岁男性于1990年4月30日因持续发热18个月入住我院。入院检查发现白细胞计数升高和贫血，而浅表淋巴结、肝脏和脾脏未触及，遂进行了骨髓穿刺和活检。骨髓活检结果显示有肉芽肿证据。5月10日左右，患者出现肝脾肿大和左颈部淋巴结肿大。根据淋巴结活检结果，诊断为霍奇金病，并于5月20日开始采用CHOP方案治疗。然而，患者出现间质性肺炎并于7月3日死亡。该患者的疾病表现为不明原因发热。骨髓活检显示以组织细胞为主的肉芽肿，随后患者出现淋巴结肿大。根据活检结果，其疾病被诊断为霍奇金病。与骨髓、肝脏或脾脏肉芽肿相关的恶性淋巴瘤大多在疾病晚期发现。然而，应该记住的是，一些患者可能在淋巴结肿大或肝脾肿大之前就在骨髓中出现肉芽肿形成，如本例所示。
