Fever of unknown origin: Chronic lymphatic leukemia versus lymphoma (Richter's transformation)
Fever of unknown origin: Chronic lymphatic leukemia versus lymphoma (Richter's transformation)
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DOI：
10.1016/j.hrtlng.2004.08.006
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发表时间：
2005-11-01
期刊：
影响因子：
2.8
通讯作者：
Parchuri, S
中科院分区：
文献类型：
--
作者：
Cunha, BA;Mohan, S;Parchuri, S
目前，恶性肿瘤比感染更常见，是成人不明原因发热（FUO）的原因。许多恶性疾病与发热有关，发热可能是类似传染病的脓毒血症，也可能是长期和低度发热。任何一种发热的新生儿都可能表现为FUO。通常伴有发热的恶性肿瘤是淋巴网状细胞恶性肿瘤，累及血液、肝脏、脾脏或骨髓。大多数恶性肿瘤没有杠杆，例如，慢性淋巴细胞白血病（CLL），作为其临床表现的一部分。我们提出了一个长期慢性淋巴细胞白血病的情况下，老年妇女谁提出了FUO。最初，人们认为她的FUO是由CLL或CLL相关的机会性感染引起的。在这个CLL和FUO患者中使用萘普生试验来区分恶性肿瘤和感染性病因。她对萘普生的反应表明，她的FUO的病因是肿瘤性的，而不是感染性的。没有扁桃体肿大和周围淋巴结病，以及发烧的存在，反对CLL作为她发烧的原因。计算机轴向断层扫描显示除了脾肿大以外，还有中央淋巴结病。发热、脾肿大和中央淋巴结病的存在表明她FUO的原因是淋巴瘤（里希特转化）而不是CLL。
Currently, malignancies are more common than infections as a cause of fever of unknown origin (FUO) in adults. Many malignant disorders are associated with fever, which may either be of the hectic-septic variety resembling an infectious disease or prolonged and low-grade. Neoplasms with either kind of fever may present as an FUO. The malignancies usually associated with fever are lymphoreticular malignancies involving the blood, liver, spleen, or bone marrow. Most malignancies do not have lever, e.g., chronic lymphatic leukemia (CLL), as part of their clinical presentation. We present a case of longstanding CLL in an elderly woman who presented with an FUO. Initially, it was thought that her FUO was caused by CLL or a CLL-related opportunistic infection. The naprosyn test was used in this patient with CLL and FUO to differentiate a malignant from an infectious etiology. Her response to naprosyn indicated that the etiology of her FUO was neoplastic rather than infectious. The absence of tonsillar enlargement and peripheral adenopathy, as well as the presence of fever, argued against CLL as the cause of her fever. Computed axial tomography scans showed central adenopathy in addition to splenomegaly. The presence of fever, splenomegaly, and central adenopathy indicated that the cause of her FUO was a lymphoma (Richter's transformation) and not CLL.