Zhang Xuehan, Zhang Qi, Cao Xinxin, Wang Yu, Huang Xiaoming, Jiao Yang
Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing St. Beijing, Beijing, 100730, China.
Ann Hematol. 2025 Feb;104(2):1157-1164. doi: 10.1007/s00277-025-06188-2. Epub 2025 Jan 14.
Recognizing and diagnosing lymphoma in patients with fever of unknown origin (FUO) can be challenging, and misdiagnosis is not uncommon. To improve understanding of the clinical characteristics of lymphoma patients presenting with FUO who were misdiagnosed with autoimmune diseases. A retrospective, observational study of 140 consecutive patients with FUO and lymphoma presenting to a tertiary center between January 2017 and December 2023. Patients were divided into those who were correctly diagnosed and those misdiagnosed as connective tissue diseases (CTD) and the clinical features compared. Of 140 lymphoma patients with FUO, 21 patients (15.0%) were misdiagnosed as CTD. The median time between symptom onset and diagnosis was significantly longer in the misdiagnosed group than in the non-misdiagnosed group (11.0 (IQR 6.0, 22.5) months vs. 4.0 (2.5, 9.0) months; p = 0.001). The misdiagnosed group had significantly less lymph node and bone marrow involvement and more skin rashes than the non-misdiagnosed group (47.6% vs. 70.6%, p = 0.039; 23.8% vs. 47.9%, p = 0.040; 47.6% vs. 25.2%, p = 0.036), as well as significantly lower ESR (p = 0.026) and hsCRP (p = 0.049). The misdiagnosed group had higher frequency of ANA/ANCA (57.1% vs. 27.7%; p = 0.008) and anti-phospholipid antibody (42.9% vs. 6.1%; p = 0.008) positivity. The distribution of lymphoma subtypes was different between groups (p = 0.058). Lymphoma patients with an atypical presentation and FUO suggesting inflammatory systemic disease are easily misdiagnosed. Autoantibody positivity is not rare in lymphoma patients with an atypical presentation and FUO, so close follow-up and repeated histopathological examination may be helpful to establishing a correct diagnosis.
在不明原因发热（FUO）患者中识别和诊断淋巴瘤具有挑战性，误诊并不罕见。为了更好地了解表现为FUO且被误诊为自身免疫性疾病的淋巴瘤患者的临床特征。对2017年1月至2023年12月期间在一家三级中心就诊的140例连续的FUO合并淋巴瘤患者进行了一项回顾性观察研究。将患者分为正确诊断的患者和被误诊为结缔组织病（CTD）的患者，并比较其临床特征。在140例FUO合并淋巴瘤患者中，21例（15.0%）被误诊为CTD。误诊组症状出现至诊断的中位时间显著长于未误诊组（11.0（IQR 6.0，22.5）个月对4.0（2.5，9.0）个月；p = 0.001）。与未误诊组相比，误诊组的淋巴结和骨髓受累明显较少，皮疹较多（47.6%对70.6%，p = 0.039；23.8%对47.9%，p = 0.040；47.6%对25.2%，p = 0.036），同时血沉（ESR）（p = 0.026）和超敏C反应蛋白（hsCRP）（p = 0.049）显著较低。误诊组抗核抗体/抗中性粒细胞胞浆抗体（ANA/ANCA）（57.1%对27.7%；p = 0.008）和抗磷脂抗体（42.9%对6.1%；p = 0.008）阳性频率较高。淋巴瘤亚型在两组之间的分布不同（p = 0.058）。表现不典型且伴有提示炎症性全身性疾病的FUO的淋巴瘤患者容易被误诊。在表现不典型且伴有FUO的淋巴瘤患者中自身抗体阳性并不罕见，因此密切随访和重复组织病理学检查可能有助于确立正确诊断。
