类风湿关节炎合并T-细胞大颗粒淋巴细胞白血病1例及文献复习

doi:10.3969/j.issn.1004-583X.2022.08.010

摘要/Abstract

摘要：

目的探讨类风湿关节炎(rheumatoid arthritis,RA)合并T-细胞大颗粒淋巴细胞白血病(T-cell large granular lymphocytic leukemia, T-LGLL)的临床特点。方法回顾性分析南京医科大学第四附属医院收治的1例 RA合并T-LGLL患者的临床资料、诊疗经过并复习相关文献。结果患者为男性,64岁, 多关节肿痛10年,乏力2年。伴有中性粒细胞减少、脾大。结合患者病史、体格检查及辅助检查,入院诊断:RA,费尔蒂综合征(Felty’s syndrome,FS)。后完善相关辅助检查并结合其临床表现,确诊为T-LGLL。给予免疫抑制剂、糖皮质激素等对症治疗后,患者乏力症状改善,无关节肿痛。结论 RA和T-LGLL可能存在类似的发病途径。对RA患者,当发展为FS时,需警惕合并T-LGLL可能。

关键词: 关节炎, 类风湿, 费尔蒂综合征, T细胞-大颗粒淋巴细胞白血病

Abstract:

Objective To explore the clinical characteristics of rheumatoid arthritis (RA) complicated with T-cell large granular lymphocytic leukemia (T-LGLL). Methods The study was aiming to retrospectively analyze the clinical data, diagnosis and treatment process of a RA patient complicated with T-LGLL admitted to The Fourth Affiliated Hospital of Nanjing Medical University, and reviewing related literatures. Results The patient was a 64-year-old man with multiple joint swelling and pain for 10 years and fatigue for 2 years. The disease course was complicated with neutropenia and splenomegaly. In combination with the patient's medical history, physical examination and auxiliary examination, the following findings of admission diagnosis were made: RA, Felty's syndrome (FS).The admission diagnosis results (RA, and Ferty's syndrome [FS]) were made in combination with the case history, physical examination, and auxiliary examination.The patient was confirmed to have T-LGLL after supplementing relevant auxiliary examination and combining corresponding clinical manifestations.The patient's fatigue symptoms were improved without joint swelling and painafter the symptomatic treatment of immunosuppressant and glucocorticoid. Conclusion For patients with RA, RA and T-LGLL may have similar pathogenesis. It is necessary to be alert to the possibility of T-LGLL when developing FS.

Key words: arthritis, rheumatoid, Felty’s syndrome, T-cell large granular lymphocytic leukemia

中图分类号:

R593.22

张月月, 谢美芳, 孙艮. 类风湿关节炎合并T-细胞大颗粒淋巴细胞白血病1例及文献复习[J]. 临床荟萃, 2022, 37(8): 728-732.

Zhang Yueyue, Xie Meifang, Sun Gen. Rheumatoid arthritis complicated with T-cell large granular lymphocytic leukemia: A case report and literature review[J]. Clinical Focus, 2022, 37(8): 728-732.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.08.010

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I8/728

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参考文献 22

[1]	Jin S, Li M, Fang Y, et al. Chinese registry of rheumatoid arthritis (CREDIT): II.prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis[J]. Arthritis Res Ther, 2017, 19(1): 251. doi: 10.1186/s13075-017-1457-z URL
[2]	Dinmohamed AG, Brink M, Visser O, et al. Population-based analyses among 184 patients diagnosed with large granular lymphocyte leukemia in the Netherlands between 2001 and 2013[J]. Leukemia, 2016, 30(6):1449-1451. doi: 10.1038/leu.2016.68 pmid: 27055870
[3]	Rodrigues L, da Silva GN, de Lacerda AP. Felty's syndrome-a rare case of febrile neutropenia[J]. Arch Clin Cases, 2021, 6(2):48-52. doi: 10.22551/2019.23.0602.10153 URL
[4]	Turesson C, Jacobsson LT, Sturfelt G, et al. Rheumatoid factor and antibodies to cyclic citrullinated peptides are associated with severe extra-articular manifestations in rheumatoid arthritis[J]. Ann Rheum Dis, 2007, 66(1):59-64. pmid: 16901955
[5]	符海. 慢性风湿性关节炎新的诊断标准(美国风湿病协会1987年修订)[J]. 临床荟萃, 1991, 6(3):129.
[6]	Ko KM, Moon SJ. Prevalence, incidence, and risk factors of malignancy in patients with rheumatoid arthritis: A nationwide cohort study from Korea[J]. Korean J Intern Med, 2021.
[7]	Cansu DÜ, Teke HÜ, Bodakçi E, et al. How should we manage low-dose methotrexate-induced pancytopenia in patients with rheumatoid arthritis?[J]. Clin Rheumatol, 2018, 37(12):3419-3425. doi: 10.1007/s10067-018-4242-8 pmid: 30056523
[8]	Gupta A, Abrahimi A, Patel A. Felty syndrome: A case report[J]. J Med Case Rep, 2021, 15(1):273. doi: 10.1186/s13256-021-02802-9 URL
[9]	Lamy T, Moignet A, Loughran TP Jr. LGL leukemia: From pathogenesis to treatment[J]. Blood, 2017, 129(9):1082-1094. doi: 10.1182/blood-2016-08-692590 pmid: 28115367
[10]	Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127(20):2375-2390. doi: 10.1182/blood-2016-01-643569 pmid: 26980727
[11]	Barilà G, Calabretto G, Teramo A, et al. T cell large granular lymphocyte leukemia and chronic NK lymphocytosis[J]. Best Pract Res Clin Haematol, 2019, 32(3):207-216. doi: S1521-6926(19)30039-8 pmid: 31585621
[12]	Dearden C. Large granular lymphocytic leukaemia pathogenesis and management[J]. Br J Haematol, 2011, 152(3):273-283. doi: 10.1111/j.1365-2141.2010.08494.x URL
[13]	Moignet A, Lamy T. Latest advances in the diagnosis and treatment of large granular lymphocytic leukemia[J]. Am Soc Clin Oncol Educ Book, 2018, 38:616-625. doi: 10.1200/EDBK_200689 pmid: 30231346
[14]	Schwaneck EC, Renner R, Junker L, et al. Prevalence and characteristics of persistent clonal T cell large granular lymphocyte expansions in rheumatoid arthritis: A comprehensive analysis of 529 patients[J]. Arthritis Rheumatol, 2018, 70(12):1914-1922. doi: 10.1002/art.40654 URL
[15]	Gorodetskiy V, Probatova N, Sidorova Y, et al. The non-leukemic T cell large granular lymphocytic leukemia variant with marked splenomegaly and neutropenia in the setting of rheumatoid arthritis - Felty syndrome and hepatosplenic T cell lymphoma mask[J]. Am J Blood Res, 2021, 11(3):227-237.
[16]	Gorodetskiy VR, Sidorova YV, Kupryshina NA, et al. Analysis of a single-institution cohort of patients with Felty's syndrome and T-cell large granular lymphocytic leukemia in the setting of rheumatoid arthritis[J]. Rheumatol Int, 2021, 41(1):147-156. doi: 10.1007/s00296-020-04757-4 pmid: 33280072
[17]	Zhang C, Ma K, Yang Y, et al. Glaucocalyxin A suppresses inflammatory responses and induces apoptosis in TNF-a-induced human rheumatoid arthritis via modulation of the STAT3 pathway[J]. Chem Biol Interact, 2021, 341:109451. doi: 10.1016/j.cbi.2021.109451 URL
[18]	Savola P, Brück O, Olson T, et al. Somatic STAT3 mutations in Felty syndrome: An implication for a common pathogenesis with large granular lymphocyte leukemia[J]. Haematologica, 2018, 103(2):304-312. doi: 10.3324/haematol.2017.175729 pmid: 29217783
[19]	Rajala HL, Olson T, Clemente MJ, et al. The analysis of clonal diversity and therapy responses using STAT3 mutations as a molecular marker in large granular lymphocytic leukemia[J]. Haematologica, 2015, 100(1):91-99. doi: 10.3324/haematol.2014.113142 pmid: 25281507
[20]	Shi M, He R, Feldman AL, et al. STAT3 mutation and its clinical and histopathologic correlation in T-cell large granular lymphocytic leukemia[J]. Hum Pathol, 2018, 73:74-81. doi: S0046-8177(17)30483-5 pmid: 29288042
[21]	Lamy T, Loughran TP Jr. How I treat LGL leukemia[J]. Blood, 2011, 117(10):2764-2774. doi: 10.1182/blood-2010-07-296962 pmid: 21190991
[22]	Lobbes H, Dervout C, Toussirot E, et al. Rituximab for rheumatoid arthritis-associated large granular lymphocytic leukemia, a retrospective case series[J]. Semin Arthritis Rheum, 2020, 50(5):1109-1113. doi: 10.1016/j.semarthrit.2020.05.020 URL