貌似结核性脑膜炎的系统型ALK阴性间变性大细胞淋巴瘤临床分析  

Systemic anaplastic lymphoma kinase negative anaplastic large cell lymphoma resembling tuberculous meningitis:a case report

作　　者：杨莹雪[1] 王雅杰[2] 朴月善[2] 林华[1] Yang Yingxue;Wang Yajie;Piao Yueshan;Lin Hua(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]首都医科大学宣武医院病理科,北京100053

出　　处：《脑与神经疾病杂志》2024年第8期463-467,共5页Journal of Brain and Nervous Diseases

基　　金：国家自然科学基金项目(51977205)。

摘　　要：目的报道1例首发症状表现为脑膜炎的系统型间变性大细胞淋巴瘤(ALCL)的诊治经过,以加深对该类疾病的认识。方法分析1例表现为发热、头痛、颅压升高,曾疑诊为结核性脑膜炎的系统型淋巴瘤激酶(ALK)阴性系统型ALCL患者的临床表现与诊治经过。结果本例患者38岁男性,以头痛、持续颅内压升高为突出表现,同时伴有发热、体质量下降、淋巴结增大等全身症状、脑脊液白细胞数量和蛋白含量增高、葡萄糖下降,给予抗病毒、抗结核治疗后病情仍反复,最终通过颈部淋巴结活检,诊断为系统型ALK阴性ALCL。结论系统型ALK阴性ALCL以脑部病变为首发症状者误诊率高,对于不符合常见神经系统疾病病程和转归特点,伴有发热、体质量下降、淋巴结肿大者,应考虑到淋巴瘤可能,积极行病理检查,争取早期诊断,改善患者预后。Objective To report the diagnosis and treatment of a case of systemic anaplastic large cell lymphoma(ALCL)whose first symptom manifested as meningitis,in order to deepen the understanding of this disease.Methods We analyzed the clinical features of a patient with anaplastic lymphoma kinase(ALK)-negative ALCL who was suspected of tuberculous meningitis and presented with fever,headache,and persistent elevation of cranial pressure.Results The patient was a 38-year-old male with headache and persistent elevated intracranial pressure as prominent manifestations,along with systemic symptoms such as fever,weight loss,enlarged lymph nodes.Cerebrospinal fluid(CSF)examination revealed elevated white cell count and protein,and decreased glucose.Antiviral and anti-tuberculosis therapy were given,which were ineffective.According to the pathological results of cervical lymph node biopsy,he was finally diagnosed with systemic ALK-negative ALCL.Conclusion The misdiagnosis rate of systemic ALK-negative ALCL is high in those who have brain lesions as the first symptom.For those who do not meet the characteristics of common neurological diseases in terms of disease course and regression,accompanied by fever,weight loss,and enlarged lymph nodes,the possibility of lymphoma should be considered,and pathologic examination should be performed actively to strive for early diagnosis and to improve the patient's prognosis.

关 键 词：间变性大细胞淋巴瘤 ALK阴性 脑膜炎 结核 

分 类 号：R512.3[医药卫生—内科学]