临床误诊误治
臨床誤診誤治
림상오진오치
Clinical Misdiagnosis & Mistherapy
2015年
9期
13-16
,共4页
吴婷婷%章必成%冉启杰%邓文娟%饶智国%高建飞
吳婷婷%章必成%冉啟傑%鄧文娟%饒智國%高建飛
오정정%장필성%염계걸%산문연%요지국%고건비
POEMS综合征%浆细胞瘤%误诊%糖尿病%胸膜炎%荨麻疹%腺癌
POEMS綜閤徵%漿細胞瘤%誤診%糖尿病%胸膜炎%蕁痳疹%腺癌
POEMS종합정%장세포류%오진%당뇨병%흉막염%담마진%선암
POEMS syndrome%Plasmacytoma%Misdinogsis%Diabetes mellitus%Pleurisy%Urticaria%Adenocarcinoma
目的:探讨POEMS综合征的临床特点及诊断要点,以减少误诊误治。方法回顾分析1例长期误诊的POEMS综合征患者的临床资料,并复习相关文献。结果本例因间断气促2年余,双下肢麻木并发现肋骨病变9个月,全身皮肤瘙痒7个月,跛行3个月入院。曾在外院行实验室检查及CT、全身骨扫描、胸腔穿刺抽液等诊断为糖尿病、结核性胸膜炎;后患者出现全身皮肤瘙痒又诊断为慢性荨麻疹及皮肤瘙痒症,胸腔积液反复出现又诊断为转移性腺癌待排等。此次入院后行PET-CT、骨病灶穿刺、骨髓穿刺及免疫组织化学等检查明确诊断为POEMS综合征,并接受全身化疗及局部放疗,病情明显缓解。结论 POEMS综合征是一种罕见的独立的克隆性浆细胞疾病,临床表现涉及全身多个系统,治疗以化疗、放疗为主;加强对此病的认识,可减少或避免误诊误治。
目的:探討POEMS綜閤徵的臨床特點及診斷要點,以減少誤診誤治。方法迴顧分析1例長期誤診的POEMS綜閤徵患者的臨床資料,併複習相關文獻。結果本例因間斷氣促2年餘,雙下肢痳木併髮現肋骨病變9箇月,全身皮膚瘙癢7箇月,跛行3箇月入院。曾在外院行實驗室檢查及CT、全身骨掃描、胸腔穿刺抽液等診斷為糖尿病、結覈性胸膜炎;後患者齣現全身皮膚瘙癢又診斷為慢性蕁痳疹及皮膚瘙癢癥,胸腔積液反複齣現又診斷為轉移性腺癌待排等。此次入院後行PET-CT、骨病竈穿刺、骨髓穿刺及免疫組織化學等檢查明確診斷為POEMS綜閤徵,併接受全身化療及跼部放療,病情明顯緩解。結論 POEMS綜閤徵是一種罕見的獨立的剋隆性漿細胞疾病,臨床錶現涉及全身多箇繫統,治療以化療、放療為主;加彊對此病的認識,可減少或避免誤診誤治。
목적:탐토POEMS종합정적림상특점급진단요점,이감소오진오치。방법회고분석1례장기오진적POEMS종합정환자적림상자료,병복습상관문헌。결과본례인간단기촉2년여,쌍하지마목병발현륵골병변9개월,전신피부소양7개월,파행3개월입원。증재외원행실험실검사급CT、전신골소묘、흉강천자추액등진단위당뇨병、결핵성흉막염;후환자출현전신피부소양우진단위만성담마진급피부소양증,흉강적액반복출현우진단위전이성선암대배등。차차입원후행PET-CT、골병조천자、골수천자급면역조직화학등검사명학진단위POEMS종합정,병접수전신화료급국부방료,병정명현완해。결론 POEMS종합정시일충한견적독립적극륭성장세포질병,림상표현섭급전신다개계통,치료이화료、방료위주;가강대차병적인식,가감소혹피면오진오치。
Objective To explore the clinical characteristics and diagnosis criteria of POEMS syndrome, so as to re-duce the misdiagnosis and mistherapy rates. Methods Clinical data of one long time misdiagnosed case of POEMS syndrome was analyzed retrospectively. Meanwhile, the related literature was reviewed. Results The patient was admitted for intermit-tent tachypnea for over 2 years, acroanesthesia of lower limbs and costopathy for 9 months, skin itching for 7 months, limping for 3 months. At first, he was diagnosed as having diabetes mellitus, tuberculous pleuritis by laboratory tests, CT, bone scan-ning and pleural pathology in other hospitals. Then he was diagnosed as having chronic urticaria, skin pruritus for itchy skin, and metastatic adenocarcinoma ( to be excluded) for repeated hydrothorax. Finally, the patient was diagnosed as having PO-EMS syndrome in our hospital by the combination of PET-CT, bone lesions biopsy, bone marrow aspiration and immunohisto-chemisty, and underwent chemotherapy and radiotherapy, and the patient was in a remission. Conclusion POEMS syndrome is a rare, independent monoclonal plasma cell disorder, which has the clinical manifestations relaled to many systems and the therapeutic methods including chemotherapy and radiotherapy. Strengthening the awareness of this disease is helpful to avoid the misdiagnosis and mistherapy.