NEJM:雨滴颅骨-病例报道

2018-05-17 xing.T MedSci原创

骨髓活检和抽吸样本证实骨髓中有50%的克隆浆细胞,血清蛋白电泳显示为单克隆IgA旁蛋白。最初的治疗包括红细胞输血治疗贫血和补液纠正高钙血症。患者对诱导治疗反应不好,诊断3个月后死亡。

患者为一名46岁的男子,因疲劳、呼吸急促、腰痛1个月,并在过去10个月期间体重减轻30公斤而就诊。
 
体检时,结膜和手掌苍白。实验室检查发现血红蛋白水平为4.9g/dL(参考范围为12至16),肌酐水平为5.4mg/ml(480μmol/L;参考范围为0.4-1 mg/ml [35-88μmol/L)],钙水平为12mg/dL(3mmol/L),参考范围为8.9-10.3 mg/ml [2.2-2.6 mmol/L]。




骨骼测量显示弥漫性骨质减少、耻骨骨折和颅骨上存在许多放射状病变,其外观被称为“雨滴颅骨”-一种类似于雨滴撞击表面和溶解或穿孔的病变。这些发现是多发性骨髓瘤的特征。
 
骨髓活检和抽吸样本证实骨髓中有50%的克隆浆细胞,血清蛋白电泳显示为单克隆IgA旁蛋白。最初的治疗包括红细胞输血治疗贫血和补液纠正高钙血症。患者对诱导治疗反应不好,诊断3个月后死亡。
 
原始出处:
 
Fabio Solis,et al. Raindrop Skull.N Engl J Med 2018. https://www.nejm.org/doi/full/10.1056/NEJMicm1714471
 
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  1. [GetPortalCommentsPageByObjectIdResponse(id=322292, encodeId=b5b2322292d2, content=这种颅骨一碰就碎, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Thu Jun 07 18:50:38 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317491, encodeId=f77f31e49102, content=多发性骨髓瘤, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Tue May 22 10:22:44 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315941, encodeId=aa1d31594197, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Thu May 17 09:43:03 CST 2018, time=2018-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315920, encodeId=a32931592074, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 17 08:40:35 CST 2018, time=2018-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315917, encodeId=1d3431591ef5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu May 17 08:33:33 CST 2018, time=2018-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315905, encodeId=140631590589, content=单从颅骨平片及临床病史首先考虑骨髓瘤., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu May 17 07:45:28 CST 2018, time=2018-05-17, status=1, ipAttribution=)]
    2018-06-07 沙漠浪人

    这种颅骨一碰就碎

    0

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    2018-05-22 沙漠浪人

    多发性骨髓瘤

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=322292, encodeId=b5b2322292d2, content=这种颅骨一碰就碎, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Thu Jun 07 18:50:38 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317491, encodeId=f77f31e49102, content=多发性骨髓瘤, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Tue May 22 10:22:44 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315941, encodeId=aa1d31594197, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Thu May 17 09:43:03 CST 2018, time=2018-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315920, encodeId=a32931592074, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 17 08:40:35 CST 2018, time=2018-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315917, encodeId=1d3431591ef5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu May 17 08:33:33 CST 2018, time=2018-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=315905, encodeId=140631590589, content=单从颅骨平片及临床病史首先考虑骨髓瘤., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu May 17 07:45:28 CST 2018, time=2018-05-17, status=1, ipAttribution=)]
    2018-05-17 329523732

    不错

    0

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    2018-05-17 龙胆草

    学习谢谢分享

    0

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    2018-05-17 zdvfsadb

    学习了

    0

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    2018-05-17 邓启付

    单从颅骨平片及临床病史首先考虑骨髓瘤.

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