Ratnayake Saman, Ammar Ali, Rezvani Rodd, Petersen Greti
Kern Medical Center, Bakersfield, CA, USA.
J Investig Med High Impact Case Rep. 2015 Sep 30;3(4):2324709615609385. doi: 10.1177/2324709615609385. eCollection 2015 Oct-Dec.
We present a case of a 65-year-old Hispanic man with a history of disseminated cutaneous coccidioidomycosis who presented to the emergency room for progressively worsening abdominal pain associated with shortness of breath. The patient was found to have pleural effusion and moderate ascites on physical examination. Abdominal ultrasound and computed tomography scan were consistent with moderate ascites and portal hypertension but negative for both liver cirrhosis and for venous or arterial thrombosis. Cytology of ascitic fluid was suggestive of portal hypertension and was negative for infection. Subsequent, thoracentesis was suggestive of exudative effusion and also negative for infection. Liver biopsy confirmed the absence of cirrhosis. Complete blood count indicated pancytopenia, whereas bone marrow biopsy and flow cytometry were suggestive of marginal zone lymphoma (MZL). Clinically, the patient's shortness of breath was resolved by thoracentesis and paracentesis; however, his abdominal pain persisted. A diagnosis of idiopathic noncirrhotic portal hypertension in the setting of splenic MZL was made. The patient was transferred to a higher level of care for splenectomy; however, he missed multiple appointments. Since discharge, the patient has been seen in the outpatient setting and states that he is controlling his disease with diet and exercise; however, he continues to complain of intermittent shortness of breath with exertion.
我们报告一例65岁的西班牙裔男性病例，该患者有播散性皮肤球孢子菌病病史，因腹痛进行性加重并伴有呼吸急促而就诊于急诊室。体格检查发现患者有胸腔积液和中度腹水。腹部超声和计算机断层扫描显示中度腹水和门静脉高压，但肝硬化、静脉或动脉血栓形成均为阴性。腹水细胞学检查提示门静脉高压，感染阴性。随后，胸腔穿刺术提示渗出性胸腔积液，感染也为阴性。肝活检证实无肝硬化。全血细胞计数显示全血细胞减少，而骨髓活检和流式细胞术提示边缘区淋巴瘤（MZL）。临床上，患者的呼吸急促通过胸腔穿刺术和腹腔穿刺术得到缓解；然而，他的腹痛持续存在。诊断为脾脏MZL背景下的特发性非肝硬化门静脉高压。患者被转至更高水平的医疗机构进行脾切除术；然而，他多次爽约。自出院以来，患者一直在门诊就诊，并表示通过饮食和运动控制病情；然而，他仍继续抱怨运动时间歇性呼吸急促。
