Department of Pediatrics, Children's National Health System, Washington, District of Columbia; and.
Division of Radiology, Mid-Atlantic Permanente Medical Group, Mclean, Virginia.
Pediatrics. 2018 Nov;142(5). doi: 10.1542/peds.2017-2959. Epub 2018 Oct 4.
A 17-year-old girl presented to her primary care physician with a history of unintentional weight loss and vague sensory symptoms, including tingling of her lower extremities. She had a nonrevealing neurology workup and a largely normal rheumatology workup apart from mild elevation in her inflammatory markers. She also had a nonfocal examination apart from a posterior cervical lymph node (2 × 1 cm). Given that she was well appearing, with a nonfocal examination and only mild laboratory abnormalities, she was told to follow-up with rheumatology in 3 months. Around that time, she re-presented to her medical home for a well-child visit, during which she was noted to have continued weight loss, now amounting to 17 lb in 1 year, and marked further elevation in her inflammatory markers. Her laboratory results were also significant for a profound microcytic anemia requiring inpatient admission for blood transfusion. During her admission, she was seen by the rheumatology, gastroenterology, and oncology subspecialty teams. Despite imaging studies and extensive laboratory workup, there was no unifying diagnosis at the time of her hospital discharge. Ultimately, an outpatient imaging study revealed the etiology.
一位 17 岁女孩因非故意体重减轻和模糊的感觉症状（包括下肢刺痛）就诊于她的初级保健医生。她的神经系统检查结果无明显异常，风湿病学检查结果除炎症标志物轻度升高外基本正常。她的检查也没有明显异常，只有一个后颈淋巴结（2×1 厘米）肿大。鉴于她表现良好，检查无明显异常，只有轻度实验室异常，医生告诉她 3 个月后再去风湿病科就诊。大约在这个时候，她因常规健康检查再次到她的医疗之家就诊，期间她被注意到体重持续减轻，在 1 年内体重减轻了 17 磅，炎症标志物进一步显著升高。她的实验室结果还显示严重的小细胞性贫血，需要住院输血。住院期间，她接受了风湿病学、胃肠病学和肿瘤学亚专科团队的诊治。尽管进行了影像学研究和广泛的实验室检查，但在她出院时仍没有明确的诊断。最终，一项门诊影像学研究揭示了病因。
