Ascer Elia, Ascer Liv Goldstein, Gidlund Magnus
Department of Immunology, University of Sao Paulo, Sao Paulo, Brazil.
BMJ Case Rep. 2011 Jun 29;2011:bcr0520114217. doi: 10.1136/bcr.05.2011.4217.
This case report concerns a 40-year-old patient with an unspecific abdominal pain, diarrhoea, a big axillary mass and a previous pulmonary infection. After biopsy of the axillary mass the diagnosis of lymphoma was excluded based on the presence of cells expressing polyclonal antibodies. Abdominal CT scans and angionuclear magnetic resonance showed an extensive intestinal venous thrombosis. The patient also presented positive results for C and S proteins, lupic anticoagulant factor and antiphospholipid antibodies (anticardiolipin antibodies - IgM and IgG). Treatment started with administration of recombinant tissue plasminogen activator and heparin which decreased the degree of thrombosis. Antibiotics were also administrated to treat pulmonary and abdominal infections. After 25 days, he was discharged with no signs of infection, no abdominal pain and reduction of the thrombosis. He was medicated with warfarin, hydroxichloroquine and clopidogrel. Forty-five days after discharge, abdominal CT scan showed a significant regression of thrombosis.
本病例报告涉及一名40岁患者,其有非特异性腹痛、腹泻、腋窝巨大肿块及既往肺部感染史。对腋窝肿块进行活检后,基于表达多克隆抗体的细胞的存在排除了淋巴瘤诊断。腹部CT扫描和血管核磁共振显示广泛的肠道静脉血栓形成。该患者C蛋白、S蛋白、狼疮抗凝因子和抗磷脂抗体(抗心磷脂抗体 - IgM和IgG)检测结果也呈阳性。治疗开始时给予重组组织型纤溶酶原激活剂和肝素,这降低了血栓形成程度。还使用了抗生素治疗肺部和腹部感染。25天后,患者出院,无感染迹象、无腹痛且血栓形成减轻。患者接受华法林、羟氯喹和氯吡格雷治疗。出院45天后,腹部CT扫描显示血栓形成显著消退。