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老年坏死性结节病样肉芽肿病病例报告并文献复习

Necrotizing sarcoid granulomatosis in an elderly patient:a case report and review of the literature

摘要:

Objective To analyze and summarize the clinical characteristics,diagnosis and treatment of necrotizing sarcoid granulomatosis(NSG).Methods A description of an elderly patient with NSG who was diagnosed through biopsy and received treatment at Beijing Hospital and a review of the literature on 73 NSG cases reported in China and elsewhere.Results The patient was a 60-year-old woman presenting with fever,cough and chest pain.Chest CT scan showed multiple miliary nodules without mediastinal adenopathy.A biopsy specimen was taken via thoracoscopy and a diagnosis of NSG was confirmed microscopically.The patient was not given any medication and experienced spontaneous remission.An analysis of a total of 74 NSG cases(including this one and 73 others from literature)shows that 22 of the patients were male and 52 female,aged from 8 to 77 years.Of all the cases,62 involved the lungs alone,while the rest implicated extrapulmonary tissues.The most common complaints were cough(37 cases or 50.0%),fever(28 cases or 37.8%)and chest pain(25 cases or 33.8%).The main imaging findings included multiple pulmonary nodules (38 cases or 51.4%),a solitary nodule (19 cases or 25.7 %),diffuse infiltrates (29 cases or 39.5 %) and hilar or mediastinal adenopathies(26 cases or 35.1%).All the cases received definitive diagnosis through biopsy.As for management,41 were treated with glucocorticoids,10 received local surgical resection only,and 20 cases were not given any treatment.Follow-ups ranging from one month to 12 years saw improvement in 68 cases.Conclusions NSG is a rare benign granulomatous disorder.Since it is often misdiagnosed as GPA or Sarcoidosis,its diagnosis needs to be confirmed through surgical pathology.NGS is usually responsive to glucocorticoids and has a generally favorable prognosis.

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