Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
BMJ Case Rep. 2022 Aug 26;15(8):e249668. doi: 10.1136/bcr-2022-249668.
We report the case of a school-aged boy who presented with clinical features suggesting acute appendicitis. However, further imaging which included CT, demonstrated an inflammatory mass involving the transverse colon raising the suspicion of lymphoma. He then developed intestinal obstruction, and in view of the rapid progression of the disease, he was thought to have non-Hodgkin's lymphoma. He underwent an open excisional biopsy, which revealed a necroinflammatory process and no suggestion of lymphoma or an alternative malignancy or specific diagnosis. His steroid treatment was stopped, and he made a good recovery postoperatively. Positive COVID-19 antibodies, positive response to steroids, results and clinical features were consistent with paediatric inflammatory multisystem syndrome (PIMS-TS), with extensive investigation not offering an alternative diagnosis.While PIMS-TS is a relatively new entity, we believe that this case highlights the importance of it being considered a differential diagnosis of a child presenting with an inflammatory mass.
我们报告了一例学龄期男孩,其临床表现提示急性阑尾炎。然而,进一步的影像学检查(包括 CT)显示横结肠有炎症性肿块,提示淋巴瘤。随后他出现肠梗阻,鉴于疾病的快速进展,考虑为非霍奇金淋巴瘤。他接受了开放性切除活检,结果显示为坏死性炎症过程,没有提示淋巴瘤或其他恶性肿瘤或特定诊断。他的类固醇治疗被停止,术后恢复良好。新冠病毒抗体阳性、对类固醇的阳性反应、检查结果和临床特征均符合儿童炎症性多系统综合征(PIMS-TS),广泛的检查未提供其他诊断。虽然 PIMS-TS 是一个相对较新的实体,但我们认为这个病例强调了在儿童出现炎症性肿块时,应将其作为鉴别诊断之一。