Haykal Tarek, Sundus Saira, Bachuwa Ghassan, Danish Rizwan
Hurley Medical Center, Flint, Michigan, USA.
BMJ Case Rep. 2019 Jan 22;12(1):e227703. doi: 10.1136/bcr-2018-227703.
This is a case of a 67-year-old woman, known to have multiple medical problems, mainly papillary thyroid cancer status post-total thyroidectomy and cervical neck dissection in addition to radioactive iodine currently in remission for 1 year, who presented to the hospital with severe weakness and fatigue. The initial workup showed significant hypercalcaemia and suppressed Parathyroid hormone (PTH). The patient was treated with hydration and pamidronate and her hypercalcaemia and symptoms improved. The differential was wide, however, a CT scan of the chest, abdomen and pelvis did show multiple liver and splenic nodular lesions; therefore, malignancy was the highest possible diagnosis. Biopsy of the splenic lesion confirmed the diagnosis of sarcoidosis. Therefore, the patient was diagnosed with primary isolated nodular hepatosplenic sarcoidosis mimicking malignancy and causing significant symptomatic hypercalcaemia.
这是一例67岁女性患者，她患有多种疾病，主要是乳头状甲状腺癌，已行全甲状腺切除术及颈部淋巴结清扫术，目前接受放射性碘治疗，病情缓解1年，此次因严重虚弱和疲劳入院。初步检查显示明显高钙血症，甲状旁腺激素（PTH）受抑制。患者接受了补液和帕米膦酸治疗，高钙血症及症状有所改善。鉴别诊断范围广泛，然而，胸部、腹部和骨盆的CT扫描确实显示肝脏和脾脏有多个结节性病变；因此，恶性肿瘤是最有可能的诊断。脾脏病变活检确诊为结节病。因此，该患者被诊断为原发性孤立性肝脾结节病，酷似恶性肿瘤并导致明显的症状性高钙血症。
