Intravascular Lymphoma Presenting as Fever of Unknown Origin

血管內淋巴瘤以持續發燒表現

溫武慶(Wu-Ching Uen) ； 林家義(Ka-Ee Ling)

《台灣癌症醫學雜誌》 29卷1期 (2013/04) Pp. 28-33

https://doi.org/10.6323/JoCRP.2013.29.1.4

摘要

亞洲變異型血管內淋巴瘤是一種罕見的結節外瀰漫性大B細胞淋巴瘤，好發於亞洲族群，以小血管內淋巴細胞株增生表現，臨床上會出現發燒，血球低下，肝脾腫大及骨髓侵蝕等表徵。本論文的此個案是一名59歲男性，以持續兩個星期的不明原因發燒為主訴，初步身體檢查發現肝脾腫大，肝功能異常，全血球低下及乳酸脫氫酶上升。血液細菌培養，血清檢查，免疫檢查及炎症掃瞄都呈現陰性。最後經骨髓切片檢查診斷為血管內淋巴瘤。給予高劑量類固醇治療後卻出現急性腫瘤溶解症候群而導致病人的死亡。骨髓檢查是重要的診斷工具，可提供早期診斷並且增加救治機會。

關鍵字

血管內淋巴瘤 ； 發燒 ； 腫瘤溶解症候群

並列摘要

The Asian variant of intravascular lymphoma (AIVL) is a rare subtype of extranodal diffuse large B cell lymphoma characterized by proliferation of clonal lymphocytes within small vessels, reported mainly in Asia, clinically characterized by fever, cytopenias, hepatosplenomegaly and bone marrow invasion. We report a 59-year-old man presenting with fever of unknown origin for 2 weeks. Initial investigation revealed hepatosplenomegaly, abnormal liver function tests, cytopenias and markedly elevated lactate dehydrogenase. Blood cultures, serology, autoimmune screen and Galium scan were not diagnostic. The fever persisted despite empirical antibiotic treatment. The diagnosis of IVL was based on iliac bone marrow biopsy. He was treated with high-dose methyprednisolone. Unfortunately, acute tumor lysis syndrome developed, which led to the patient’s death. Early detection of the disease is a challenge, and a prompt bone marrow examination along with proper evaluation of certain clinical manifestations may enhance the chances of improving prognosis.

並列關鍵字

intravascular lymphoma ； fever ； tumor lysis syndrome