严重的高热血病揭示了急性淋巴细胞白血病:一个病例报告
Ibtissam Maach1,2, Meriem M El Achiwi1,3,2, Karima Ryouni1,2
1Pediatrics, Hôpital Mère-Enfant Abderrahim Harouchi, Casablanca, MAR.
Cureus
|January 28, 2026
概括
儿童严重的高血症可能是急性淋巴细胞白血病 (ALL) 的信号. 这一案例凸显了ALL最初如何在没有典型的血液或骨髓异常的情况下出现,强调了如果问题仍然存在,需要重复骨髓评估的必要性.
科学领域:
- 儿科血液学/瘤学
- 儿科内分泌学 儿科内分泌学
- 儿科重症监护 儿科重症监护
背景情况:
- 高血症是儿童罕见的代谢障碍,往往具有严重的潜在原因.
- 恶性高血症可能导致危及生命的并发症,包括意识改变和心律失常.
- 儿童高血症的初始表现可能各不相同,有时可能会误导.
研究的目的:
- 报告一个罕见的儿科高血症病例作为B细胞急性淋巴细胞白血病 (ALL) 的初始表现.
- 强调ALL所带来的诊断挑战,呈现出看似孤立的高血症和正常的初始骨髓发现.
- 突出在非典型的儿科高热血病病例中的连续骨髓评估的重要性.
主要方法:
- 一个2.5岁的男性患有严重的高血症,低血症和维生素D缺乏症的病例报告.
- 最初的调查包括广泛的病因检查,成像 (放射学,部成像) 和骨髓吸收.
- 由于持续和非典型的发现,随后进行了骨髓评估,从而诊断出B细胞ALL.
主要成果:
- 该患者出现严重的高血症 (21.2 mg/dL),高血症,低血症和维生素D缺乏症,需要儿科重症监护.
- 最初的骨髓吸血和血液学计数正常;然而,成像显示了骨解病变.
- 重复的骨髓检查最终证实了B细胞急性淋巴细胞白血病,随后发生了全细胞衰竭和对化疗的良好反应.
结论:
- 超血症,有或没有骨解性病变,可能是儿童急性淋巴细胞白血病的唯一初始表现.
- 早期的骨髓评估可能是错误的保证,当临床或成像发现令人担忧时,需要重复评估.
- 这一案例强调了在儿科高血症中考虑恶性瘤的关键重要性,特别是在非典型特征的情况下,以及连续骨髓检查的价值.
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