肺瘤血栓性微血管病变模仿免疫治疗相关的肺炎
Hayley McKenzie1, Deborah Scott2, Adrian C Bateman3
1Oncology, University Hospital Southampton NHS Trust, Southampton, UK.
BMJ case reports
|September 28, 2023
概括
肺瘤血栓性微血管病变 (PTTM) 是癌症患者的罕见并发症,特别是那些接受免疫治疗的人. 这一案例凸显了在患有不明原因的缺氧和血小板狭窄症的患者中考虑PTTM的重要性.
科学领域:
- 在瘤学瘤学.
- 病理学 病理学 病理学
- 免疫学 免疫学 免疫学
背景情况:
- 辅助免疫疗法越来越多地用于切除的三阴性乳腺癌.
- 肺瘤血栓性微血管病变 (PTTM) 是一种罕见但严重的疾病.
- 区分PTTM与免疫治疗相关的不良事件可能具有挑战性.
研究的目的:
- 在接受辅助免疫治疗的三阴性乳腺癌患者中报告PTTM病例.
- 在这种背景下,突出 PTTM 的临床表现和诊断挑战.
- 强调在癌症患者无法解释心肺衰竭的差异诊断中考虑PTTM的重要性.
主要方法:
- 案例报告的呈现方式.
- 临床发现的审查,包括肝功能测试,缺氧,血小板减少和右心力衰竭.
- 讨论差异诊断,包括免疫治疗相关的肝炎和肺炎.
- 尸体解剖检查结果 (隐含).
主要成果:
- 患者出现了肝功能测试的失调,严重的缺氧,血小板减少和右心力衰竭.
- 尽管得到了支持性护理,但病情迅速恶化,死于呼吸衰竭.
- PTTM的诊断在死后得到证实.
- 该患者有切除的三阴性乳腺癌病史,接受了辅助免疫治疗.
结论:
- 应考虑在癌症患者中进行PTTM,特别是那些患有特定亚型和接受免疫治疗的癌症患者,这些患者表现为肝功能障碍,缺氧,血小板减少和右心力衰竭的组合.
- 这种情况的预后非常糟糕,经常被诊断为死后.
- 迅速识别PTTM可能会在未来的病例中考虑新的治疗策略.
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