1病例简介 男,32岁,主诉:小便不能自解、双下肢无力10 d.既往有复发性关节炎病史.查体:双上肢肌力4+级,双上肢肌张力正常,双下肢肌力0级,双下肢肌张力低,双上肢腱反射(+),双下肢腱反射(?),双侧巴宾斯基征未引出.
Background: Sarcoidosis is a systemic non-caseous necrotizing granulomatous disease with unknown etiology. It can involve multiple organs throughout the body, most commonly affecting lungs and/or bilateral hilar lymph nodes. Sjögren's syndrome is a multi-system autoimmune disease. The main clinical symptoms include dry mouth and dry eyes. The combination of the two diseases with the involvement of multiple systems is very rare, and the final diagnosis is mainly based on the comprehensive judgment of clinical history, imaging manifestations and pathological examination. Case presentation: We report a case of multiple sarcoidosis (lung, hilar, mediastinal, inguinal, liver, and spleen) with Sjögren syndrome. The patient had a dry mouth, dry eyes, and bilateral parotid gland enlargement. The first computed tomography (CT) scan of the chest and abdomen showed multiple nodules in the lungs, multiple enlarged lymph nodes, and low-density shadows in the liver and spleen. After a one-year interval, the re-examination showed that the lung lesions increased with bead-like changes, and the lymph nodes shrunk. Through pathological puncture and comprehensive judgment, considering the coexistence of the two diseases, the patient improved after hormone therapy and was finally diagnosed. Conclusion: Multisystem sarcoidosis combined with Sjögren's syndrome has rarely been reported in the literature. This case has multiple imaging examinations, pathological data and a follow-up review after treatment. The dynamic changes in different periods will help us to better understand the situation of sarcoidosis and explore the connection between the two diseases so as to reduce misdiagnosis.
1 临床资料 患者,女, 25 岁,因"反复咳嗽、咳痰 1 年余"于2021年9月15日入院诊治.患者1年前劳累受凉后出现咳嗽,以干咳为主,偶咳少量白色泡沫样痰,无畏寒发热,无胸痛咯血,外院查胸部CT示双肺间质纤维化改变,自行服药(具体不详)后症状仍有反复.患者自述入职体检胸片( 2019 年)示两肺弥漫性病变.既往无吸烟史,无外源性过敏原接触史.家族史:其父亲2006年发现肺纤维化、肺大疱,2011年去世;其二叔因肺心病去世.
