Adhikari Pratik, Bhujel Nabin
Koirala Institute of Health Sciences, Dharan.
College of Medical Sciences, Bharatpur, Chitwan, Nepal.
Ann Med Surg (Lond). 2024 Aug 26;86(10):6203-6207. doi: 10.1097/MS9.0000000000002482. eCollection 2024 Oct.
Neurofibromatosis type I (NF1) is a genetic disorder characterized by the development of multiple benign tumors along nerves in the skin, brain, and other parts of the body. It is associated with a range of clinical manifestations, including skin lesions, neurofibromas, and ocular abnormalities, which can significantly impact a patient's quality of life. Management of NF1 is particularly challenging in resource-limited settings due to limited access to diagnostic and therapeutic resources.
A 62-year-old woman with a known history of NF1 presented with progressive visual impairment. Her condition began in childhood with multiple hyperpigmented skin macules, which developed into numerous cutaneous tumors over time. Examination revealed numerous neurofibromas, café-au-lait spots, and axillary freckling. Significant visual impairment was caused by large fibromas on her eyelids. Histological analysis confirmed benign nerve tissue tumors.
The management strategy in this resource-limited setting focused on regular monitoring, patient education, symptomatic treatment, and multidisciplinary care. Despite the limitations, the patient's condition was managed effectively through these adapted strategies. The importance of genetic testing for confirmation and further management was noted but not performed due to resource constraints.
This case highlights the complexities of managing NF1 in resource-limited settings, emphasizing the need for adaptable management approaches. Multidisciplinary care and patient education were crucial in improving the patient's quality of life. This case underscores the importance of early diagnosis and intervention to prevent complications like visual impairment.
1型神经纤维瘤病(NF1)是一种遗传性疾病,其特征是在皮肤、大脑和身体其他部位的神经上形成多个良性肿瘤。它与一系列临床表现相关,包括皮肤病变、神经纤维瘤和眼部异常,这些可显著影响患者的生活质量。由于获得诊断和治疗资源有限,在资源匮乏地区对NF1的管理尤其具有挑战性。
一名有NF1已知病史的62岁女性出现进行性视力损害。她的病情始于童年,有多个色素沉着过度的皮肤斑疹,随着时间的推移发展成大量皮肤肿瘤。检查发现有大量神经纤维瘤、咖啡斑和腋窝雀斑。眼睑上的大纤维瘤导致了严重的视力损害。组织学分析证实为良性神经组织肿瘤。
在这个资源有限的环境中,管理策略侧重于定期监测、患者教育、对症治疗和多学科护理。尽管存在局限性,但通过这些调整后的策略有效地管理了患者的病情。注意到基因检测对于确诊和进一步管理的重要性,但由于资源限制未进行检测。
本病例突出了在资源有限地区管理NF1的复杂性,强调了需要采用适应性管理方法。多学科护理和患者教育对于改善患者生活质量至关重要。本病例强调了早期诊断和干预以预防视力损害等并发症的重要性。