Zhu W J, Wang J, He X H, Qin Y, Yang S, Hu X S, Wang H Y, Huang J, Zhou A P, Ma F, Shi Y K, Zhou S Y
Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2020 Apr 23;42(4):305-311. doi: 10.3760/cma.j.cn112152-20200303-00166.
To investigate the principles of differential diagnosis of pulmonary infiltrates in cancer patients during the outbreak of novel coronavirus (2019-nCoV) by analyzing one case of lymphoma who presented pulmonary ground-glass opacities (GGO) after courses of chemotherapy. Baseline demographics and clinicopathological data of eligible patients were retrieved from medical records. Information of clinical manifestations, history of epidemiology, lab tests and chest CT scan images of visiting patients from February 13 to February 28 were collected. Literatures about pulmonary infiltrates in cancer patients were searched from databases including PUBMED, EMBASE and CNKI. Among the 139 cancer patients who underwent chest CT scans before chemotherapy, pulmonary infiltrates were identified in eight patients (5.8%), five of whom were characterized with GGOs in lungs. 2019-nCoV nuclear acid testing was performed in three patients and the results were negative. One case was a 66-year-old man who was diagnosed with non-Hodgkin lymphoma and underwent CHOP chemotherapy regimen. His chest CT scan image displayed multiple GGOs in lungs and the complete blood count showed decreased lymphocytes. This patient denied any contact with confirmed/suspected cases of 2019-nCoV infection, fever or other respiratory symptoms. Considering the negative result of nuclear acid testing, this patient was presumptively diagnosed with viral pneumonia and an experiential anti-infection treatment had been prescribed for him. The 2019 novel coronavirus disease (COVID-19) complicates the clinical scenario of pulmonary infiltrates in cancer patients. The epidemic history, clinical manifestation, CT scan image and lab test should be taken into combined consideration. The 2019-nCoV nuclear acid testing might be applied in more selected patients. Active anti-infection treatment and surveillance of patient condition should be initiated if infectious disease is considered.
通过分析1例化疗后出现肺部磨玻璃影(GGO)的淋巴瘤患者,探讨新型冠状病毒(2019 - nCoV)疫情期间癌症患者肺部浸润的鉴别诊断原则。从病历中检索符合条件患者的基线人口统计学和临床病理数据。收集2月13日至2月28日就诊患者的临床表现、流行病学史、实验室检查及胸部CT扫描图像信息。从包括PUBMED、EMBASE和CNKI在内的数据库中检索有关癌症患者肺部浸润的文献。在139例化疗前接受胸部CT扫描的癌症患者中,8例(5.8%)发现肺部浸润,其中5例肺部表现为GGO。对3例患者进行了2019 - nCoV核酸检测,结果均为阴性。1例66岁男性,诊断为非霍奇金淋巴瘤,接受CHOP化疗方案。其胸部CT扫描图像显示肺部多发GGO,全血细胞计数显示淋巴细胞减少。该患者否认与2019 - nCoV感染确诊/疑似病例有任何接触,无发热或其他呼吸道症状。考虑到核酸检测结果为阴性,该患者初步诊断为病毒性肺炎,并给予经验性抗感染治疗。2019新型冠状病毒病(COVID - 19)使癌症患者肺部浸润的临床情况变得复杂。应综合考虑流行病学史、临床表现、CT扫描图像及实验室检查。2019 - nCoV核酸检测可应用于更多有选择的患者。如果考虑为传染病,应启动积极的抗感染治疗并监测患者病情。