Nakamura Takaaki, Takai Yoshiki, Kaneko Kimihiko, Kuroda Hiroshi, Misu Tatsuro, Asanuma Kiyotaka, Saito Ryoko, Aoki Masashi
Department of Neurology, Tohoku University School of Medicine, Japan.
Department of Gastroenterology, Tohoku University Graduate School of Medicine, Japan.
Intern Med. 2020 Feb 15;59(4):573-576. doi: 10.2169/internalmedicine.3093-19. Epub 2019 Oct 7.
A 66-year-old woman presented with upper abdominal pain and weakness in the limbs. She had bilateral uveitis and gastric ulcers. A neurological examination revealed tetraparesis and sensory disturbance in the right arm. A cerebrospinal fluid (CSF) examination showed polymorphonuclear pleocytosis with elevated pro-inflammatory cytokine levels. Magnetic resonance imaging showed brain lesions and a long spinal cord lesion. She was initially diagnosed with neuro-Behçet's disease and was treated with corticosteroids, resulting in no improvement. A gastric mucosa biopsy indicated T-cell lymphoma colocalizing with neutrophils. The cytokine-mediated neutrophilic inflammation probably caused characteristic CSF and histopathological features. It is noteworthy that T-cell lymphoma may present with CSF neutrophilic inflammation.
一名66岁女性因上腹部疼痛和肢体无力就诊。她患有双侧葡萄膜炎和胃溃疡。神经系统检查发现四肢瘫痪和右臂感觉障碍。脑脊液（CSF）检查显示多形核白细胞增多，促炎细胞因子水平升高。磁共振成像显示脑部病变和脊髓长节段病变。她最初被诊断为神经白塞病，并接受了皮质类固醇治疗，但病情无改善。胃黏膜活检显示T细胞淋巴瘤与中性粒细胞共定位。细胞因子介导的嗜中性粒细胞炎症可能导致了特征性的脑脊液和组织病理学特征。值得注意的是，T细胞淋巴瘤可能表现为脑脊液嗜中性粒细胞炎症。
