继发于心脏T细胞淋巴瘤的暴发性心肌炎
Fulminant Myocarditis Secondary to Cardiac T-Cell Lymphoma.
作者信息
Wang Yifei, Li Huan, Gao Shanquan, Liu Yuanwei, Li Lihong, Han Zhiwei, Wang Yilu, Zhang Ping, Yin Hongfang, He Rong
机构信息
Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China.
Department of Pathology, Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China.
出版信息
JACC Case Rep. 2025 Aug 20;30(24):104743. doi: 10.1016/j.jaccas.2025.104743.
BACKGROUND
Cardiac T-cell lymphoma is a rare and aggressive malignancy that often presents with nonspecific symptoms and is difficult to diagnose early.
CASE SUMMARY
A 73-year-old man presented with syncope, anorexia, and abdominal discomfort. During hospitalization, he developed hypereosinophilia and rapidly progressed to fulminant myocarditis. Despite steroid and immunoglobulin therapy, cardiac function declined, requiring extracorporeal membrane oxygenation and intra-aortic balloon pump support. Myocardial biopsy confirmed cardiac T-cell lymphoma with lymphocytic infiltration.
DISCUSSION
Cardiac T-cell lymphoma with fulminant myocarditis is exceptionally rare and carries a poor prognosis. Diagnosis is often delayed because of vague symptoms. This case highlights the value of early myocardial biopsy and histopathologic evaluation in rapidly deteriorating cardiac function.
TAKE-HOME MESSAGES: Early myocardial biopsy is crucial in cases of unexplained myocarditis with rapid deterioration. Cardiac T-cell lymphoma is a rare and aggressive condition that can rapidly progress to fulminant myocarditis in certain cases, necessitating early diagnosis and intervention.
背景
心脏T细胞淋巴瘤是一种罕见的侵袭性恶性肿瘤，常表现为非特异性症状，早期难以诊断。
病例摘要
一名73岁男性出现晕厥、厌食和腹部不适。住院期间，他出现嗜酸性粒细胞增多，并迅速发展为暴发性心肌炎。尽管接受了类固醇和免疫球蛋白治疗，但心脏功能仍下降，需要体外膜肺氧合和主动脉内球囊泵支持。心肌活检证实为心脏T细胞淋巴瘤伴淋巴细胞浸润。
讨论
伴有暴发性心肌炎的心脏T细胞淋巴瘤极为罕见，预后不良。由于症状模糊，诊断往往延迟。本病例强调了早期心肌活检和组织病理学评估在心脏功能迅速恶化中的价值。
要点
对于原因不明且迅速恶化的心肌炎病例，早期心肌活检至关重要。心脏T细胞淋巴瘤是一种罕见且侵袭性的疾病，在某些情况下可迅速发展为暴发性心肌炎，需要早期诊断和干预。
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