Harborne Serena L, Curley Rachael, Bullimore David W, Chan-Lam Dominic, Ng Jean-Pierre, McAndrew Philip T
Barnsley Hospital Foundation Trust, Haematology, Gawber Road, Barnsley, S75 2EP, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.08.2008.0639. Epub 2009 May 17.
A 70-year-old lady with a past medical history of light chain myeloma, chronic renal failure and a left breast plasmacytoma treated with radiotherapy was admitted for drainage of a subsequent left pleural effusion. She was given high dose steroids for her myeloma, following which she developed abdominal pain suspicious of pancreatitis. Results revealed a raised serum amylase of 5117, a modified Glasgow score of 3 and normal calcium levels. The working diagnosis was drug-induced pancreatitis and steroids were stopped. She remained well and her abdominal pain settled, but amylase remained markedly raised despite no findings of pancreatic pathology. A subsequent isoenzyme test on the amylase found it to be salivary amylase secreted from the plasmacytoma. The patient had her steroid therapy restarted and was allowed to be discharged from hospital.
一位70岁女性，既往有轻链骨髓瘤、慢性肾衰竭病史，曾接受放疗治疗左侧乳腺浆细胞瘤，此次因随后出现的左侧胸腔积液引流入院。她因骨髓瘤接受了大剂量类固醇治疗，之后出现腹痛，怀疑为胰腺炎。检查结果显示血清淀粉酶升高至5117，改良格拉斯哥评分为3分，血钙水平正常。初步诊断为药物性胰腺炎，遂停用类固醇。她情况良好，腹痛缓解，但尽管未发现胰腺病变，淀粉酶仍显著升高。随后对淀粉酶进行的同工酶检测发现其为浆细胞瘤分泌的唾液淀粉酶。患者重新开始类固醇治疗后获准出院。
