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A 58-Year-Old Woman with Abdominal Symptoms and Elevated C-Reactive Protein 英文参考文献
Learning Forum
A 58-Year-Old Woman with Abdominal
Symptoms and Elevated C-Reactive Protein
Marie-Louise Daly, David J. Cartwright, Paul J. Lehner, Babak Javid
*
D E S C R I P T I O N o f C A S E
What Was the New Differential Diagnosis?
A
Raised inflammatory markers with sacro-iliac pain suggested
sacro-iliitis, and would be consistent with past or present
inflammatory bowel disease. Infectious and inflammatory
causes are the most common; blood cultures and early
morning urine specimens were sought, but failed to grow
mycobacteria or other pathogens. Plain radiographs of the
lumbo-sacral spine revealed no evidence of sacro-iliitis or
fracture. Given the ongoing abdominal symptoms, imaging
of the abdomen with ultra-sound was arranged to allow
investigation of abscesses or masses. This showed mild fatty
infiltration of the liver and a probable angiomyolipoma in the
lower pole of the right kidney.
58-year-old woman presented to her primary care
physician in April 2002 complaining of troubling
abdominal symptoms. She described abdominal
bloating and pain with frequent diarrhoea and modest
weight loss. There was no history of fevers or rigors. She
had a background of irritable bowel syndrome, monoclonal
gammopathy of uncertain significance (MGUS), ureteric
stones, hysterectomy, and fracture of her left tibia and
fibula. Investigations for possible inflammatory bowel disease
in the 1980s had been negative. Investigations revealed
normal electrolytes, renal function coeliac screen, and full
blood count, but raised rheumatoid factor, an erythrocyte
sedimentation rate of 26 mm/hr, and a C-reactive protein
(CRP) level of more than 250 mg/l (Addenbrooke’s Hospital
does not quantify CRP at levels of more than 250 mg/l).
Because of the raised inflammatory markers, she was referred
for further evaluation to the infectious diseases clinic at
Addenbrooke’s Hospital.
Is MGUS Entirely Benign? Could It Account for the
Patient’s Condition?
Re-assessment of the patient in clinic in
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