Department of Nephrology, Odense University Hospital, Odense, Denmark
Department of Clinical Pathology, Odense University Hospital, Odense, Denmark.
BMJ Case Rep. 2022 May 18;15(5):e247805. doi: 10.1136/bcr-2021-247805.
We present a case of a young kidney transplanted man. He was admitted with lymphadenopathy, fluctuating fever and night sweats 2 months after a cat bite. After admission, he developed severe pain around his right hip. An F-fluorodeoxyglucose (FDG)-positron emission tomography/CT revealed intense FDG-uptake in lymph nodes, spleen and bone, suggestive of lymphoma. An extracted lymph node showed confluent granulomas, microabscesses with neutrophils and scattered multinucleated giant cells histologically. The patient had history of latent tuberculosis and proteinase 3 -anti-neutrophil cytoplasmic antibodies associated (PR3-ANCA) vasculitis, making differential diagnostic considerations complicated. antibodies was detected in blood and DNA in a lymph node. He was started on doxycycline and rifampicin. Due to severe drug interactions with both tacrolimus and increasing morphine doses, rifampicin was changed to azithromycin. He received 12 days of relevant antibiotic treatment and responded well. He was discharged after 16 days with close follow-up and was still in habitual condition 12 months later.
我们报告了 1 例年轻的肾移植男性患者。他在被猫咬伤后 2 个月因淋巴结病、波动发热和盗汗而入院。入院后，他的右髋部周围出现严重疼痛。氟代脱氧葡萄糖（FDG）-正电子发射断层扫描/计算机断层扫描（PET/CT）显示淋巴结、脾脏和骨骼中 FDG 摄取明显增加，提示淋巴瘤。提取的淋巴结组织学显示融合性肉芽肿、微脓肿伴中性粒细胞和散在多核巨细胞。患者有潜伏性结核病和蛋白酶 3-抗中性粒细胞胞质抗体相关（PR3-ANCA）血管炎病史，使鉴别诊断变得复杂。血液中检测到抗 PR3 抗体，淋巴结中检测到 DNA。他开始服用多西环素和利福平。由于与他克莫司和吗啡剂量增加的严重药物相互作用，将利福平改为阿奇霉素。他接受了 12 天的相关抗生素治疗，反应良好。他在 16 天后出院，进行了密切随访，12 个月后仍处于习惯性状态。
