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首页> 外文期刊>Clinical immunology: The official journal of the Clinical Immunology Society >Diarrhea as sole presentation of Good's syndrome mimicking Crohn's disease
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Diarrhea as sole presentation of Good's syndrome mimicking Crohn's disease

机译：腹泻是模仿克罗恩氏病的Good's综合征的唯一表现

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1. Introduction Primary' immunodeficiency (PID) is a rare cause of hypogammaglobulinemia. The commonest cause of PID in the elderly is Good's syndrome (GS). PID is frequently associated with diarrhea [1]. However, in the absence of an established diagnosis of PID and in the presence of sole chronic diarrhea at presentation, diagnosis can be challenging. 2. Case report A previously healthy 63 year-old woman presented after three months of diarrhea and 13 kg weight loss. At presentation, stools were negative for bacterial and parasitological growth. Endoscopy revealed pancolitis with scanty erosions. Histology showed chronic inflammation with lymphocytes, plasma cells, histiocytes, eosinophils and neutrophil infiltration extending to submucosa, cryptitis, rare criptic abscesses and some epithelioid granuloma, considered suggestive of Crohn's disease (CD). Budesonide 9 mg and azathioprine 150 mg were started without clinical improvement. Three months later, CMVPCR were 28,000 copies/mL and stools were positive for Clostridium difficile toxins. Further cultures revealed Escherichia coli and Enterobacter faecaiis in urine and Campylobacter jejuni in stools. Moreover, a subcutaneous abscess was drained from the left leg. Chest CT revealed a mediastinal mass considered suggestive of thyroid struma. She was treated with both valganciclovir and levofloxacin ev, and oral vancomycin. Because of persistence of diarrhea and appearance of fever, she was admitted to the Gastroenterology Unit. At admission, objective exam was negative.
机译：1.简介原发性免疫缺陷症（PID）是低血球蛋白血症的罕见原因。老年人PID的最常见原因是古德氏综合症（GS）。 PID常与腹泻有关[1]。然而，在没有确定的PID诊断的情况下，并且在呈现时仅存在慢性腹泻的情况下，诊断可能具有挑战性。 2.病例报告腹泻三个月和体重减轻13公斤后出现了一位以前健康的63岁女性。演讲时，粪便对细菌和寄生虫的生长呈阴性。内镜检查发现胰腺炎伴糜烂。组织学显示慢性炎症，淋巴细胞，浆细胞，组织细胞，嗜酸性粒细胞和嗜中性粒细胞浸润扩展至粘膜下层，隐膜炎，罕见的rare疮脓肿和一些上皮样肉芽肿，被认为提示克罗恩病（CD）。布地奈德9毫克和硫唑嘌呤150毫克在没有临床改善的情况下开始使用。三个月后，CMVPCR为28,000拷贝/ mL，粪便中艰难梭菌毒素呈阳性。进一步的培养显示尿液中有大肠杆菌和粪肠杆菌，粪便中有空肠弯曲菌。此外，左腿引流皮下脓肿。胸部CT显示发现有纵隔肿块，提示有甲状腺组织。她接受了valganciclovir和levofloxacin ev以及口服万古霉素的治疗。由于腹泻的持续性和出现发烧，她被送进了肠胃病科。入学时，客观检查为阴性。

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