医学
贝伐单抗
淋巴管瘤病
纵隔
放射科
活检
呼吸衰竭
惠普尔病
外科
内科学
疾病
病理
淋巴系统
化疗
作者
Douglas Tjandra,Andrew Brett,Anand Murugasu
出处
期刊:Case Reports
[BMJ]
日期:2023-10-01
卷期号:16 (10): e256460-e256460
标识
DOI:10.1136/bcr-2023-256460
摘要
A man in his 30s with intellectual disability presented with 1 month of diarrhoea, weight loss and dyspnoea. Investigations were hampered due to significant anxiety. Laboratory tests detected microcytic anaemia and hypoalbuminaemia. CT demonstrated a fat-containing infiltrate in the mediastinum, mesentery and axillae, and pulmonary ground-glass infiltrates. Biopsy of the axilla showed cystic lymphatic malformations involving adipose tissue and lymph nodes, leading to a provisional diagnosis of generalised lymphatic anomaly. Over the subsequent 4 months, the patient’s respiratory status deteriorated, leading to type 1 respiratory failure necessitating intubation. After multidisciplinary discussion, a decision was made to trial bevacizumab, an anti-VEGF agent, with subsequent improvement in respiratory status. While intubated, gastroscopy was performed; duodenal biopsies revealed pathognomonic changes of Whipple’s disease, confirmed on PCR of duodenal and axillae biopsies. This was deemed the most likely unifying diagnosis; antibiotic treatment was commenced, bevacizumab was ceased, and the patient has remained well after 18 months.
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