CAJ | 학술논문

目的探索RA合并发热患者的诊断和鉴别诊断要领.方法对1例62岁,出现发热的女性RA患者进行详尽的临床诊治分析.结果经过骨髓穿刺涂片发现噬血细胞,实验室检查铁蛋白显著升高(74 299 ng/ml),血红蛋白(最低67 g/L)和血小板下降(最低33×109/L),纤维蛋白原减低(1.07 g/L),血清可溶性CD25 (sCD25)升高,人巨细胞病毒(CMV)DNA阳性、CMV-PP65抗原阳性,流式细胞术检测NK细胞活性减低,正电子发射型计算机断层显像(PET-CT)发现脾大和肺部炎症,经激素、依托泊苷、环孢素、抗CMV病毒治疗,患者未再发热,铁蛋白显著下降,血小板正常,最后确定诊断为巨细胞病毒感染相关的噬血细胞综合征.结论 RA患者出现发热要考虑到噬血细胞综合征的可能性.
목적 탐색RA합병발열환자적진단화감별진단요령.방법 대1례62세,출현발열적녀성RA환자진행상진적림상진치분석.결과 경과골수천자도편발현서혈세포,실험실검사철단백현저승고(74 299 ng/ml),혈홍단백(최저67 g/L)화혈소판하강(최저33×109/L),섬유단백원감저(1.07 g/L),혈청가용성CD25 (sCD25)승고,인거세포병독(CMV)DNA양성、CMV-PP65항원양성,류식세포술검측NK세포활성감저,정전자발사형계산궤단층현상(PET-CT)발현비대화폐부염증,경격소、의탁박감、배포소、항CMV병독치료,환자미재발열,철단백현저하강,혈소판정상,최후학정진단위거세포병독감염상관적서혈세포종합정.결론 RA환자출현발열요고필도서혈세포종합정적가능성.
Objective To explore the diagnostic and differential diagnostic points of patients with rheumatoid arthritis (RA) complicated with fever.Methods Full clinical analysis was performed for a 62-year old patient with RA and fever.Results Hemophagocytes were found in bone marrows smear.Significantly increased ferritin level (74 299 ng/ml),decreased hemoglobin (67 g/L) and platelet (33×109/L),decreased fibrinogen,increased serum soluble CD25 (sCD25),positive cytomegalovirus (CMV) DNA,positive CMV-PP65 antigen,were found by laboratory examination.Decreased activity of NK cells was detected by flow cytometry.Positron emission computed tomography (PET-CT) revealed splenomegaly and pulmonary inflammations.The clinical conditions were recovered with the treatment of corticosteroid,VP16,cyclosporine,anti-CMV virus therapy.Ferritin level was significantly decreased and platelet was normal.The patient was diagnosed as hemophagocytic syndrome associated with CMV infection.Conclusion The possibility of hemophagocytic syndrome should be considered in RA patients presented with fever.