12. Infectious mononucleosis (Infectious monocytosis)
Infectious mononucleosis is caused by EBV, mostly in adolescents. Clinical manifestations include fever, pharyngitis, lymph node enlargement (seen in 70% of patients, superficial lymph nodes can be involved, but the neck is the most common), hepatosplenomegaly (only 10% of patients. Liver enlargement accounts for 20%-62% of patients with upper gastrointestinal symptoms of acute hepatitis. Liver function is abnormal in up to 2/3 of patients, and some patients have mild jaundice. About half of the patients have mild splenomegaly with pain and tenderness, and occasionally splenic rupture may occur.) The skin rash (about 10% of cases. Patients have a rash that appears 1-2 weeks into the course of the disease and is polymorphic, with papules and maculopapular rash being common. There may also be urticaria or scarlet fever-like rash, and occasionally a hemorrhagic rash. The rash is usually seen in the trunk area and resolves within 1 week. (Some children may have upper eyelid puffiness.) There is a significant increase in peripheral blood lymphocytes and the presence of abnormal lymphocytes, a positive heterophilic agglutination test, and the presence of anti-EBV antibodies in the body after infection. A few severe cases may have neurological symptoms, such as aseptic meningitis, encephalitis and peripheral radiculitis. In different stages of the disease, individual patients may show clinical manifestations of different organ involvement. In the acute stage, pericarditis and myocarditis may occur. Neurological symptoms, such as Guillain-Barre syndrome and meningoencephalitis, can occur throughout the course of the disease. Occasionally, thrombocytopenic purpura may occur in the later stages. Patients may also develop nephritis, gastrointestinal bleeding (due to necrotic ulceration of lymphoid tissue), and interstitial pneumonia, etc. More than 90% of patients recover. The duration of the disease is mostly 1 to 3 weeks, and a few can be prolonged for several months. Occasionally there is a recurrence, and when there is a recurrence, the duration of the disease is short and the disease is mild. The prognosis of this disease is good, the death rate is only 1 to 2%, mostly due to serious complications.
13, malignant histiocytosis (malignant group)
It often presents with high fever, anemia, hemorrhage, enlarged lymph nodes, hepatosplenomegaly, complete blood cytopenia, and systemic failure. The diagnosis mainly relies on repeated bone marrow smears and lymph node biopsies to look for abnormal histiocytes and multinucleated macrophages of various morphologies. The disease should be differentiated from reactive histiocytosis, which is an increase in the number of histiocytes with normal morphology.
14. Systemic lupus erythematosus (SLE)
It is mostly seen in young and middle-aged women with prolonged irregular fever, typical rash, joint symptoms, symptoms of multi-organ damage, decreased white blood cells, and immunological abnormalities, etc. Some cases are accompanied by local or generalized lymph node enlargement.
15, histiocytosis X, also known as Lange-rhan (Lange-rhan) histiocytosis
It is a rare group of diseases of unknown etiology characterized mainly by hyperplasia of well-differentiated histiocytes. The lesions involve the liver and spleen, lymph nodes, lungs, bone marrow, and skin. The disease is classified into three types according to the degree of cell differentiation: ①Letterer-Siwe disease, which mostly develops within 1 year of age, with high fever, red maculopapular rash, respiratory symptoms, and enlarged liver and spleen lymph nodes; ②Hand-Schuller-Christian disease, which is mostly seen in children and (2) Hand-Schuller-Christian disease, mostly seen in children and young adults, with cranial defects, proptosis and uveitis as the three main features; (3) Eosinophilic granuloma of bone, mostly seen in children, with osteolytic destruction of long bones and flat bones as the main manifestation.
16. Leukemia
Fever, enlarged lymph nodes and liver and spleen. The diagnosis can be made based on the cell type and characteristics of primitive and naive cells in blood and bone marrow and cytochemical staining.
17. Lymphoma
Progressive painless lymph node enlargement is characteristic, and fever is often present in those with B symptoms. Diagnosis is mainly based on lymph node biopsy pathology and often requires immunohistochemistry, flow cytometry, and in some cases, chromosomal examination and gene rearrangement tests. Peripheral blood and bone marrow have important diagnostic value for certain types of lymphoma such as acute lymphoblastic leukemia and small lymphocytic lymphoma.
18. Primary macroglobulinemia (Waldenstrom, WM)
It is a special type of lymphoma. It is a malignant proliferative disease of plasma cell-like lymphocytes that secrete large amounts of Ig. The age of onset is mostly above 50 years, and the incidence is relatively low and easily misdiagnosed. Clinical manifestations include anemia (more than 80% of patients), infection, hemorrhage (more than 40% of patients), hepatosplenic lymph node enlargement (20%-40%), glomerulonephritis (<5% of patients), and neurological symptoms, visual impairment, Raynaud's phenomenon, and vascular embolism due to increased blood viscosity. Due to immune deficiency, patients are prone to bacterial infections. Osteolytic bone destruction is rare. The presence of M component in serum electrophoresis, immunoelectrophoresis confirming monoclonal IgM, and typical plasma cell-like lymphocyte infiltration in the bone marrow confirm the diagnosis.
Diagnosis is based on.
1, Elderly patients with unexplained anemia and bleeding tendency.
2. Central and/or peripheral nervous system symptoms.
3, Visual impairment.
4, Raynaud’s phenomenon.
5. Enlarged liver and spleen lymph nodes.
6.IgM >10g/L in serum.
7. There may be complete cytopenia and a small number (<5%) of atypical naive plasma cells in peripheral blood.
8, lymph-like plasma cell infiltration in bone marrow, liver, spleen and lymph nodes.
9, Increased blood viscosity.