Poponea Nicholas, Suede Mohanad, Muhsin Chisti Mohammad
Department of Internal Medicine - Hematology/Oncology, McLaren Oakland Hospital, Michigan State University College of Osteopathic Medicine, Pontiac, Michigan, USA.
Department of Internal Medicine, McLaren Oakland Hospital, Michigan State University College of Osteopathic Medicine, Pontiac, Michigan, USA.
Case Rep Oncol. 2017 Dec 19;10(3):1116-1120. doi: 10.1159/000485241. eCollection 2017 Sep-Dec.
We report a 74-year-old female who presented to the emergency department complaining of bruising and stroke-like symptoms. She underwent a negative stroke work-up but was found to have profoundly low platelets and splenomegaly on examination. An abdominal CT scan was ordered, showing pelvic lymphadenopathy. Lymphoma was suspected. However, subsequent bone marrow and lymph node biopsies showed no evidence of this. She was treated for immune thrombocytopenia purpura (ITP) to no avail while a lymphoma work-up continued. Months later, a third and final lymph node biopsy yielded evidence of Hodgkin disease (HD) and she began treatment shortly thereafter. She is currently undergoing standard treatment for this malignancy and her platelet counts have normalized. The case not only outlines the importance of the physician's gestalt in arriving at the proper diagnosis, but it also posits the thought that perhaps ITP should be considered a paraneoplastic syndrome of HD.
我们报告了一名74岁女性，她因出现瘀伤和类似中风的症状前往急诊科就诊。她接受了全面的中风检查，结果为阴性，但检查发现她血小板严重减少且脾脏肿大。随后进行了腹部CT扫描，显示盆腔淋巴结肿大。怀疑患有淋巴瘤。然而，随后的骨髓和淋巴结活检未发现淋巴瘤证据。她接受了免疫性血小板减少性紫癜（ITP）治疗，但无效，同时继续进行淋巴瘤检查。数月后，第三次也是最后一次淋巴结活检发现了霍奇金病（HD）的证据，此后不久她便开始接受治疗。她目前正在接受这种恶性肿瘤的标准治疗，血小板计数已恢复正常。该病例不仅强调了医生的整体判断在做出正确诊断中的重要性，还提出了一个观点，即或许ITP应被视为HD的副肿瘤综合征。
