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临床推理:伴有蕈样肉芽肿的 66 岁女性的进行性周围神经病。

Clinical Reasoning: Progressive Peripheral Neuropathy in a 66-Year-Old Woman With Sezary Syndrome.

机构信息

From the Second Department of Neurology (S.F., A.T., J.S.T., S.G., G.T., P.Z.), Second Department of Radiology (G.V.), Department of Neurosurgery and Neurotraumatology (L.S.), Second Department of Dermatology and Venereology (E.P.), "Attikon" University Hospital; First Department of Pathology (P.K., E.L.), "Laikon" General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis.

出版信息

Neurology. 2024 Nov 26;103(10):e209983. doi: 10.1212/WNL.0000000000209983. Epub 2024 Oct 23.

Abstract

Evaluating patients with neuropathy is common, especially in elderly patients with comorbidities. Neuropathy can often be a manifestation of systemic diseases, cancer, or drug-induced toxicity; thus, the differential diagnosis is challenging. The mechanism of nerve damage can vary significantly, affecting the patient's therapeutic management. We describe a 66-year-old woman who presented with subacute and progressively worsening motor weakness of the lower extremities with bilateral numbness and tingling after a recent respiratory tract infection. Her medical history included diabetes mellitus and Sezary syndrome in the context of cutaneous T-cell lymphoma. This case emphasizes the significance of a detailed evaluation and considering clinical signs and electrophysiologic findings in patients with neuropathy and a history of hematologic malignancy. Early recognition and management can be crucial in shaping the clinical course of the disease.

摘要

评估神经病变患者很常见,尤其是在患有合并症的老年患者中。神经病变通常可能是系统性疾病、癌症或药物诱导毒性的表现;因此,鉴别诊断具有挑战性。神经损伤的机制可能有很大差异,影响患者的治疗管理。我们描述了一位 66 岁女性,她在最近的呼吸道感染后出现亚急性和逐渐加重的下肢运动无力,伴有双侧麻木和刺痛。她的病史包括糖尿病和皮肤 T 细胞淋巴瘤背景下的蕈样真菌病。该病例强调了对有神经病变和血液系统恶性肿瘤病史的患者进行详细评估并考虑临床体征和电生理发现的重要性。早期识别和管理对于塑造疾病的临床病程至关重要。

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