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血管免疫母细胞性淋巴结病(AILD)临床少见,尤以急性腹膜炎为首发表现的更为罕见,报道1例如下。 患者男,32岁。因腹痛伴进行性腹胀2月,加剧1天于1993年11月18日入院。既往体健。体检:T37.8℃,BPl4/8kPa。神志清、痛苦貌。皮肤巩膜无黄染。心肺听诊正常。腹部稍膨隆,腹肌紧张,全腹均有压痛及反跳痛,肝脾触诊不满意,移动性浊音阳性。实验室检查:血Hb97g/L,WBC7.8×10~9/L,N0.87,L0.13,血沉122mm/h。肝功能检查示白蛋白35g/L,球蛋白46g/L,SGPT23u,AKPl2.8u。血清IgG2182mg/L,IgA164mg/L,IgM448mg/L,C_3128mg/L。B超示肝脾肿大伴少量腹水。入院后给予异烟肼、利福平、链霉素治疗,40天后出现高热呈驰张热型,体温最高达40.5℃;腹痛加剧,呈板状腹。颈部背部多处皮肤出现红色斑疹伴瘙痒。全身进行性无痛性淋巴结肿大,质地软、无压痛。淋巴结印片:原始淋巴细胞8％,幼稚淋巴细胞29％,淋巴细胞62％,组织细胞1％。淋巴结活检见:皮质结构模糊,淋巴滤泡大多消失,为成片淋巴细胞取代。血管内皮细胞增生明显,并伴较多嗜酸性粒细胞浸润,间以免疫母细胞,有一处血管壁及间质内伊红染物质沉积,髓质区淋
AIL is rare in clinical practice. Acute peritonitis is more common in the first episode. One case is reported below. Male patient, 32 years old. Due to abdominal pain with progressive bloating in February, one day exacerbation on November 18, 1993 admission. Past physical health. Physical examination: T37.8 ℃, BPl4 / 8kPa. Conscious, painful appearance. Skin sclera without yellow dye. Cardiopulmonary auscultation normal. Abdomen slightly bulging, abdominal muscle tension, the whole abdomen are tenderness and rebound tenderness, palpation of liver and spleen are not satisfied, mobility dullness positive. Laboratory tests: blood Hb97g / L, WBC7.8 × 10 ~ 9 / L, N0.87, L0.13, erythrocyte sedimentation rate 122mm / h. Liver function tests showed albumin 35g / L, globulin 46g / L, SGPT23u, AKPl2.8u. Serum IgG2182mg / L, IgA164mg / L, IgM448mg / L, C_3128mg / L. B ultrasound shows hepatosplenomegaly with a small amount of ascites. After admission to give isoniazid, rifampicin, streptomycin treatment, 40 days after the fever appeared Chi Zhang fever type, body temperature up to 40.5 ℃; abdominal pain aggravated, was plate-shaped abdomen. Multiple back of the neck red skin rash with itching. Progressive painless lymphadenopathy, soft texture, no tenderness. Lymph node prints: Primitive lymphocytes 8%, naive lymphocytes 29%, lymphocytes 62%, tissue cells 1%. Lymph node biopsy see: cortical structure fuzzy, most of the disappearance of lymphatic follicles, into a piece of lymphocyte replacement. Vascular endothelial cell hyperplasia, with more eosinophil infiltration, among immune cells, there is a blood vessel wall and interstitial eosin staining, medullary area