目的 提高对超高龄原发肠道恶性淋巴瘤复杂临床表现的认识,避免延诊和误诊.方法 回顾性分析2例超高龄原发肠道恶性淋巴瘤致长期高热及腺苷脱氨酶(ADA)升高的临床资料.结果 2例均反复高热伴腹胀、腹痛,长期使用抗菌素无效.1例后期CT检查发现回盲部肿块及肠套叠,腹膜增厚,大量腹腔积液,经腹腔积液沉渣涂片诊断为淋巴瘤.另1例2次肠镜检查示回肠末段、升结肠多发溃疡,病理结果为急慢性炎症,诊断为Crohn病,予泼尼松治疗无效,经免疫组织化学检查确诊为非霍奇金淋巴瘤(NHL).2例疾病晚期血及腹腔积液ADA、乳酸脱氢酶(LDH)明显升高,短期抗结核治疗无效.患者全身状态差,最终死亡.结论 对有消化道症状,长期发热,血及腹腔积液ADA、LDH明显升高的老年患者,应警惕恶性淋巴瘤的可能.%Objective To improve cognition of clinical diversiform and multiplex of primary intestinal lymphoma in extra elderly patients, and avoid delayed diagnosis or misdiagnosis. Methods The data of 2 patients with primary intestinal lymphoma causing long-term hyperpyrexia and high adenosine fleaminase (ADA) levels were retrospectively analyzed. Results The two patients had recurrent hyperpyrexia, abdominal distension and abdominal pain, and showed no improvement after repeated use of antibiotics. One patient underwent CT examination at the later stage of the disease, the results showed peritoneum thickness, massive ascites, intestines wall thickness, lump and intussusception of ileocecal junction, and lymphoma was confirmed after ascites sediment examination. Another patient underwent endoscopic examination, and the results showed multi ulcers on ileum and ascending colon, pathological findings showed acute and chronic inflammation, and the diagnosis was Crohn disease. Prednisone therapy was ineffective, NHL was confirmed by immunohistochemistry. In both the patients, ADA and lactate dehydrogenase (LDH) levels increased in serum and ascitic fluid. Diagnosis of tuberculous peritonitis was suspected and anti tuberculous bacilli drugs were once given for a short period but ineffectively. The patients were in poor conditions and finally died of primary disease, high fever and secondary heart failure. Conclusion For patients with long-term gastrointestinal symptoms accompanied by fever, high level ADA and LDH in serum and ascitic fluid, abdominal malignant lymphoma should be suspected.
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