Reategui Schwarz Erika, Oikonomou Katerina G, Reynolds Megan, Kim Juliette, Balmiki Rajeev L, Sterling Stephanie A
New York University, New York, NY, USA.
NYU Lutheran Medical Center, Brooklyn, NY, USA.
J Investig Med High Impact Case Rep. 2017 Jul 6;5(3):2324709617716471. doi: 10.1177/2324709617716471. eCollection 2017 Jul-Sep.
Extranodal natural killer T-cell lymphoma, nasal type (ENKL), formerly called lethal midline granuloma or angiocentric T-cell lymphoma, is a predominantly extranodal non-Hodgkin lymphoma characterized by vascular damage, necrosis, and an association with Epstein-Barr virus. In the United States, it is more frequently seen in Asian, Asian Pacific Islander, and Hispanic descent populations and is more prevalent in males in their fifth decade. Clinical presentation of NK nasal lymphoma most commonly involves epistaxis; obstruction; discharge; destructive mass in sinuses, palate, and nose; and skin ulceration. These symptoms can mimic invasive fungal infections and other sinonasal disorders. Furthermore, ENKL has a broad cytologic spectrum and induces a mixture of inflammatory cells, causing difficulty in establishing the diagnosis, especially in initial biopsies. We present a case of refractory facial cellulitis in a young woman whose treatment course was complicated by septic shock and resistance to multiple antibiotics, resulting in a delayed diagnosis of ENKL nasal type.
结外鼻型自然杀伤T细胞淋巴瘤（ENKL），以前称为致死性中线肉芽肿或血管中心性T细胞淋巴瘤，是一种主要发生于结外的非霍奇金淋巴瘤，其特征为血管损伤、坏死，并与爱泼斯坦-巴尔病毒有关。在美国，它在亚裔、亚太岛民和西班牙裔人群中更为常见，在50岁左右的男性中更为普遍。NK鼻型淋巴瘤的临床表现最常见的是鼻出血、阻塞、分泌物、鼻窦、腭部和鼻部的破坏性肿块以及皮肤溃疡。这些症状可类似于侵袭性真菌感染和其他鼻窦疾病。此外，ENKL具有广泛的细胞学谱，并诱导炎性细胞混合存在，导致诊断困难，尤其是在初次活检时。我们报告一例年轻女性难治性面部蜂窝织炎病例，其治疗过程因感染性休克和对多种抗生素耐药而复杂化，导致ENKL鼻型的诊断延迟。
