Ferreira Carlos Noronha, Barjas Elidio R, Correia Luis A, Tavares Luis, Ferreira Cristina, Serejo Fatima L, de Moura Miguel Carneiro, Monteiro Estela
Gastroenterology and Hepatology Division, Hospital Santa Maria, Lisbon, Portugal.
Nat Clin Pract Gastroenterol Hepatol. 2008 Aug;5(8):469-74. doi: 10.1038/ncpgasthep1176. Epub 2008 Jul 8.
A 62-year-old white woman was admitted to hospital with a 2-month history of progressive, painless, left supraclavicular and axillary lymph node enlargement. The patient's history was significant for chronic HCV infection, for which she had just completed a 48-week course of treatment with pegylated interferon alpha (180 microg once weekly) plus ribavirin (1,000 mg daily). She attained an end-of-treatment response and subsequent qualitative measurement of HCV RNA confirmed a sustained virological response. The onset of progressive painless lymph node enlargement had been noted by the patient during the last 2 weeks of her treatment for HCV.
Physical examination, otorhinolaryngological examination, laboratory investigations (including complete blood counts, liver function tests and serological tests), mammography, thyroid and abdominal ultrasound, CT scans, abdominal MRI, upper gastrointestinal endoscopy, colonoscopy, supraclavicular lymph node biopsy, (67)Ga scintigraphy and bronchoalveolar lavage.
Granulomatous lymphadenitis of uncertain etiology with sarcoid-type and tuberculoid-type granulomas.
Standard antituberculosis treatment with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months, followed by isoniazid and rifampicin for 7 months.
一名62岁白人女性因进行性、无痛性左锁骨上及腋窝淋巴结肿大2个月入院。患者有慢性丙型肝炎病毒（HCV）感染史，刚刚完成了为期48周的聚乙二醇化干扰素α（每周1次，180微克）联合利巴韦林（每日1000毫克）治疗。她获得了治疗结束时的应答，随后HCV RNA的定性检测证实了持续病毒学应答。患者在HCV治疗的最后2周注意到进行性无痛性淋巴结肿大的出现。
体格检查、耳鼻喉科检查、实验室检查（包括全血细胞计数、肝功能检查和血清学检查）、乳腺钼靶检查、甲状腺及腹部超声检查、CT扫描、腹部磁共振成像、上消化道内镜检查、结肠镜检查及锁骨上淋巴结活检、镓（67Ga）闪烁扫描及支气管肺泡灌洗。
病因不明的肉芽肿性淋巴结炎，伴有结节病样和结核样肉芽肿。
采用异烟肼、利福平、吡嗪酰胺和乙胺丁醇进行标准抗结核治疗2个月，随后使用异烟肼和利福平治疗7个月。
