高枚春，陈 刚，王智樱，陆钦池上海交通大学医学院附属仁济医院神经内科，上海 200127



病例报道Case Report

以头痛和复视为首发症状的嗜血细胞综合征：1例报道及文献复习

高枚春，陈 刚，王智樱，陆钦池
上海交通大学医学院附属仁济医院神经内科，上海 200127

摘要

关键词：嗜血细胞综合征；神经系统；头痛；复视；成年人

高枚春， 陈 刚， 王智樱， 等. 以头痛和复视为首发症状的嗜血细胞综合征：1例报道及文献复习［J］. 神经病学与神经康复学杂志，2016， 12（1）:52–56.

陆钦池

E-MAIL

qinchilu@yahoo.com

CONFLlCT OF lNTEREST: The authors have indicated they have no conflicts of interest to disclose.

Received Jan. 18， 2016； accepted for publication Mar. 1， 2016

Copyright © 2016 by Journal of Neurology and Neurorehabilitation

GAO Meichun， CHEN Gang， WANG Zhiying， LU Qinchi

Department of Neurology， Renji Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200127， China

LU Qinchi

E-MAIL ADDRESS

qinchilu@yahoo.com

ABSTRACT

This paper reports one adult case presenting with headache and diplopia as initial symptoms of hemophagocytic syndrome （HPS）， describing the diagnostic process and treatment outcomes， in order to improve the understanding of HPS complicated by nervous system involvement. A 55-year-old female adult case presented with headache and diplopia as initial symptoms followed by high fever was hospitalized in Department of Neurology， Renji Hospital， Shanghai Jiao Tong University School of Medicine. Admission laboratory tests revealed pancytopenia， abnormal liver function （elevated serum levels of alanine aminotransferase， aspartate aminotransferase， and lactate dehydrogenase），hypertriglyceridemia， hypofibrinogenemia and hyperferritinaemia. The results of bone marrow aspiration and biopsy showed decreased proliferation of nucleated bone marrow cells， reduction of all three hematopoietic cell lines， and hemophagocytosis of neutrophils and platelets， indicating the diagnosis of HPS. This case report suggests that when a patientpresenting with headache， diplopia， fever， and reduction of peripheral whole blood cells should be highly suspected for the possibility of secondary HPS， and the early bone marrow aspiration and biopsy is the key to make a definite diagnosis.

To cite: GAO M C， CHEN G， WANG Z Y， et al. Headache and diplopia as initial symptoms of hemophagocytic syndrome: A case report and literature review. J Neurol and Neurorehabil， 2016， 12（1）:52–56.

噬血细胞综合征（h e m o p h a g o c y t i c syndrome，HPS）是一种可能累及多个器官（包括淋巴结、皮肤、肺、肝和脾）的多系统疾病，但以骨髓受累为主［1］。HPS累及神经系统的病例报道较少，而本文报道的1例以头痛和复视为首发症状的HPS累及神经系统的病例更为罕见。

1 病例报道

患者，女性，55岁，因主诉“右侧眼眶部疼痛伴视物成双4 d”于2011年9月27日收入上海交通大学医学院附属仁济医院神经内科。患者于入院前4 d无明显诱因出现右侧眼眶部疼痛，右眼睁眼困难，自诉向前、向右视时有视物成双，伴有头晕、恶心、呕吐1次；否认视物旋转、畏光、畏声、构音障碍、耳鸣和听力下降等。患者曾于外院就诊，接受鱼腥草和玻璃酸钠滴眼液治疗，疗效欠佳，遂转至本院就诊，考虑为“痛性眼肌麻痹可能”，给予地塞米松、前列地尔和甲钴胺等治疗，仍有眼眶部疼痛及视物成双，遂收住入院。患者既往体健，否认高血压、糖尿病和冠状动脉粥样硬化等慢性病史，幼年时无头痛、头晕、腹痛、晕船和晕车等病史，否认传染病史，否认输血史，否认遗传疾病家族史。……