Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
BMC Infect Dis. 2014 Jan 27;14:42. doi: 10.1186/1471-2334-14-42.
Yersinia pseudotuberculosis generally infects the gastrointestinal tract and causes enteropathy symptoms suggesting infection. Y. pseudotuberculosis infections are often complicated with intraceliac lymphoadenopathy mimicking malignant lymphoma. This is a first case of Yersinia pseudotuberculosis enteropathy mimicking enteropathic γδ T-cell lymphoma. This case highlighted the γδ T-cell reaction to Yersinia enterocolitis sometimes mimicking malignant lymphoma clinically.
A 72-year-old female was referred to our institute due to abdominal pain with skin rush, fever and diarrhea. Computed tomography (CT) scanning revealed mucosal swelling of the cecum with enlargement of regional lymph nodes. Laboratory data showed elevated CRP (7.74 mg/dL), an increased level of soluble interleukin-2 receptor (sIL-2R 3095 IU/mL), and CD3+ γδ T-cell circulation in peripheral blood and bone marrow (10.9% and 3.9%, respectively). Increased proportions of γδ T-cells supported the diagnosis of malignant lymphoma. Colonoscopy demonstrated hemorrhagic mucosal erosion with partial ulceration, and the subsequent pathological findings at the inflammation site suggested malignant lymphoma histopathology in the colon. These objective findings were entirely consistent with enteropathic γδ T-cell lymphoma. Thereafter, however, the microbiological results of the patient's stool at admission showed Yersinia pseudotuberculosis, and she was diagnosed as having Yersinia enterocolitis. All abnormal findings including subjective symptoms were in remission or mitigated within 2 weeks after her onset. Even the γδ T-cell circulation disappeared (0.04% in peripheral blood), and we speculate that those cells were a reaction to the Yersinia infection.
In this case, a differential diagnosis included infectious enterocolitis from other immunogenic or malignant diseases. Although a measurement of sIL-2R is critical in differentiating malignant lymphoma in patients suffering with lymph adenopathy, that is not confirmative. This patient's case indicates that T cells expressing the γδ T-cell receptor might be associated with the acute and late phase reactions, in which T cells play a role in the construction of granulomas and the establishment of sequelae.
假结核耶尔森菌通常感染胃肠道，引起提示感染的肠病症状。假结核耶尔森菌感染常伴有腹腔内淋巴结病，类似于恶性淋巴瘤。这是首例假结核耶尔森菌肠病模仿肠病 γδ T 细胞淋巴瘤的病例。本病例强调了 γδ T 细胞对耶尔森氏结肠炎的反应，临床上有时类似于恶性淋巴瘤。
一名 72 岁女性因腹痛、皮疹、发热和腹泻被转介至我院。计算机断层扫描 (CT) 扫描显示盲肠黏膜肿胀，局部淋巴结肿大。实验室数据显示 C 反应蛋白升高（7.74mg/dL），可溶性白细胞介素 2 受体（sIL-2R）水平升高（3095IU/mL），外周血和骨髓中 CD3+γδ T 细胞循环增加（分别为 10.9%和 3.9%）。γδ T 细胞比例增加支持恶性淋巴瘤的诊断。结肠镜检查显示出血性黏膜糜烂伴部分溃疡，炎症部位的后续病理结果提示结肠恶性淋巴瘤组织病理学。这些客观发现与肠病性 γδ T 细胞淋巴瘤完全一致。然而，此后，患者入院时粪便的微生物学结果显示假结核耶尔森菌，诊断为假结核耶尔森菌肠炎。所有异常发现，包括主观症状，均在发病后 2 周内缓解或减轻。甚至 γδ T 细胞循环消失（外周血中为 0.04%），我们推测这些细胞是对耶尔森菌感染的反应。
在本例中，鉴别诊断包括感染性肠炎与其他免疫性或恶性疾病。虽然 sIL-2R 的测量对于区分患有淋巴结病的恶性淋巴瘤至关重要，但这并不是确定的。该患者的病例表明，表达 γδ T 细胞受体的 T 细胞可能与急性和晚期反应有关，在这些反应中，T 细胞在肉芽肿的形成和后遗症的建立中发挥作用。
