Trewby P N, Portmann B, Brinkley D M, Williams R
Q J Med. 1979 Jan;48(189):137-50.
Six patients who were referred to the liver unit on account of jaundice are described. A different initial diagnosis has been made in each case, these being fulminant hepatic failure, severe hepatitis with renal failure, toxoplasma hepatitis, extrahepatic obstruction, sclerosing cholangitis, and liver abscess. After delays of four weeks to 12 months from the time of first symptoms all six patients were eventually found to have advanced Hodgkin's disease (stage 4). In four patients the diagnosis was made during life, but in two only at autopsy. In four lymphoma tissue was finally demonstrable in the liver, but in two liver biopsy showed only minor non-specific changes despite grossly abnormal liver function tests. Three of the six patients were treated with chemotherapy, and two of these recovered sufficiently to leave hospital. With the encouraging survival figures now being obtained in Hodgkin's disease, an awareness of the varied hepatic manifestations of the disease may allow treatment to be instituted at an earlier stage.
本文描述了6例因黄疸转诊至肝病科的患者。每例患者最初的诊断均不相同，分别为暴发性肝衰竭、伴有肾衰竭的严重肝炎、弓形虫肝炎、肝外梗阻、硬化性胆管炎和肝脓肿。从首次出现症状起，经过4周至12个月的延误后，所有6例患者最终均被发现患有晚期霍奇金病（4期）。4例患者在生前确诊，但2例仅在尸检时确诊。4例患者最终在肝脏中发现了淋巴瘤组织，但2例患者尽管肝功能检查明显异常，肝脏活检仅显示轻微的非特异性改变。6例患者中有3例接受了化疗，其中2例恢复良好得以出院。鉴于目前霍奇金病取得了令人鼓舞的生存数据，认识到该疾病多样的肝脏表现可能有助于在更早阶段开展治疗。
