急性擬似薦腸骨關節炎出現在一惡淋巴瘤病人及其核磁共振造影之特徵

Acute Sacroiliitis-like Arthropathy in a Patient with Lymphocystic Lymphoma: Assessment with Magnetic Resonance Imaging

一位74歲男性病人因最近一週出現下背痛及左髖關節痛而住院治療。在14個月前曾因右後頸部淋巴腺腫大而求診，經淋巴腺病理組織切片檢查確定是惡性淋巴瘤，接受六個療程的化學治療後，病況好轉。住院後骨盆X光檢查發現無異常病灶。全身骨骼核子醫學素描檢查發現左側腸骨有較強的放射性同位素吸收，且左側薦腸骨關節吸收指數符合左側薦腸骨關節炎。但經核磁共振造影檢查卻發現左側腸骨骨內有明顯浸潤性病灶，在骨外亦有明顯浸潤性病灶出現，但有趣的是骨骼卻完整無缺。經左側腸骨病灶病理組織切片檢查確定是惡性淋巴瘤。經化學治療後，病情惡化，10天後死於Pseudomonas敗血症。以下背痛及左側髖關痛可以作為惡性淋巴瘤腫瘤以外的臨床表現。本文並強調核磁共振造影能提供早期診斷惡性淋巴瘤。

A 74-year-old male patient presented with pain and stiffiness of the low back and left hip of one week's duration. About 14 months previously, he had a right posterior cervical lymphadenopathy and non-Hodgkin's lymphoma (NHL) was proved pathologically. He received 6 courses of chemotherapy and went into clinical remission. A radiograph of the left pelvic bone showed intact bony structures. A bone scan revealed left sacroiliitis. Magnetic resonance imaging (MRI) of the pelvic bone showed an intraosseous lesion of the whole left iliac bone, partially involving LI-5, and extraosseous masses involving the left gluteus minimus, iliacus and pirformis muscles with low T1-weighted signal intensity and high T2-weighted signal intensity. However, the bony cortex remained relatively intact. NHL was subsequenty proved by bone marrow biopsy of the left iliac bone. He was given chemotherapy which consisted of prednisolone, oncovin and cyclophosphamide. However, his condition deteriorated rapidly 10 days later and he died of Pseudomonas septicemia. Rheumatic signs and symptoms may be the presenting paraneoplastic features of underlying lymphoproliferative diseases. MRI may provide a very early diagnosis of the disease.