Disseminated tuberculosis confounding a co-morbid primary CNS lymphoma.
Disseminated tuberculosis confounding a co-morbid primary CNS lymphoma.
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作者：
Tai DBG;Graffeo CS;Kotsenas A;Meyer FB;Virk A
众所周知，在免疫功能正常的患者中，原发性中枢神经系统淋巴瘤的诊断具有挑战性，因为它是一种罕见的诊断。我们报告一例同时诊断为肺结核的病例。一位60岁的女性患者出现认知障碍、记忆力减退、社交退缩、意外体重减轻和盗汗，最终确诊为多发性脑部病变和纵隔腺病。脑活检显示淋巴组织细胞浸润，纵隔结节组织病理显示坏死性肉芽肿，培养出结核分枝杆菌。这位病人开始接受抗结核治疗。然而，后续的脑MRI显示疾病进展，促使重复脑活检，这反过来证实了弥漫性大B细胞淋巴瘤的诊断。虽然不相关的同步诊断很少见，但临床上有显著混淆的可能性是相当大的--特别是在疾病标志物可能重叠的情况下，就像感染、炎症和肿瘤过程中经常发生的情况一样。本案例说明了努力排除竞争性诊断的重要性，以及在没有观察到预期发现或治疗反应时及时采取行动的重要性。
Primary central nervous system lymphoma is notoriously challenging to diagnose in immunocompetent patients as it is an uncommon diagnosis. We present a case of synchronous diagnosis with tuberculosis. A 60-year-old woman presented with cognitive difficulties, memory loss, social withdrawal, unintentional weight loss, and night sweats, the work-up of which ultimately identified multiple brain lesions and mediastinal adenopathy. Brain biopsy showed lymphohistiocytic infiltrate, while mediastinal node histopathology showed necrotizing granulomas, and cultures grew Mycobacterium tuberculosis. The patient was initiated on anti-tuberculosis therapy. However, follow-up brain MRI demonstrated disease progression, prompting repeat brain biopsy, which in turn confirmed the diagnosis of diffuse large B-cell lymphoma. Although unrelated synchronous diagnoses are rare, the potential for clinically significant confounding is considerable—particularly where disease markers may overlap, as is often the case with infectious, inflammatory, and neoplastic processes. The present case illustrates the importance of diligence in ruling out competing diagnosis, and timely action when an anticipated finding or response-to-treatment is not observed.
影响因子：
11
作者：
Mohit, AA;Santiago, P;Rostomily, R
通讯作者：
Rostomily, R