Thomas Dewland  美国加利福尼亚大学旧金山医学院内科学
    <International Circulation>:  Could you please briefly give an explanation of the case you presented today?

   《国际循环》：现在，请您对今天的这个病例做一个简要的介绍？
 
    Prof. Thomas Dewland: We presented a case of a 30 year old man who presented to our hospital with new onset heart failure in the setting of severe fevers and a history of lymphoproliferative disorder.  The diagnosis seemed evident upon his initial presentation and he was treated for what ended up being myocarditis.  Because of his classic presentation for myocarditis， his young age， and lack of risk factors for coronary disease， the familiar diagnosis of coronary artery disease was overlooked in this patient with potentially deleterious effects.  

    Dewland教授：我们的这个病例是一位30岁的青年男性，送到我们医院的时候，在高烧的情况下出现了新发的心脏衰竭，以往有一个淋巴结增生症的病史。根据他最初的表现，他最后诊断为心肌炎并接受了治疗似乎是显而易见的。因为他的心肌炎的典型表现，加上年纪太轻，并缺乏冠状动脉疾病的危险因素，因此在诊断这个患者时，忽视了常见的冠状动脉疾病的诊断，并在造成了潜在的有害影响。
 
    <International Circulation>: Can you explain a bit more about the autoimmune disorder?  I think some people may not be very familiar with it.

   《国际循环》：能否请您介绍一下有关自身免疫性疾病？我觉得有些人可能对此不是非常熟悉。
 
    Prof. Thomas Dewland: Yes， this patient’s fundamental disorder is a lymphoproliferative disorder， ALPS or autoimmune lymphoproliferative syndrome.  It is a disease that causes impairment in apoptosis of B and T cells resulting in the manifestation of autoimmune disease， hemolytic anemia， and idiopathic thrombocytopenia (ITP).

    Dewland教授：好的，这名患者的根本问题在于淋巴组织增生性疾病，ALPS或自身免疫性淋巴增生综合征。这是一种能够导致B细胞或T细胞凋亡受损的疾病，引起自身免疫性疾病，溶血性贫血和特发性血小板减少症（ITO）的表现。

    <International Circulation>: What would you say is the message that you want other doctors to take home from your case presentation?

   《国际循环》：您认为其他医生能够从您的病例介绍中学到什么知识？
 
    Prof. Thomas Dewland: The final message is that the clinical cardiologist needs to remember the common causes to common diseases and these should always be excluded first， especially when rare diagnoses are being considered.  In our case we were so fixated on what seemed to be the apparent， or perhaps rare， diagnosis of formative myocarditis in a patient with a lot of risk factors for it that the common disease of coronary artery disease was overlooked.  

    Dewland教授：从这个病例中得到的结论是，临床心脏病学医师需要记住常见疾病，并始终将其首先排除，尤其是在考虑罕见病的诊断时。在我们的病例中，由于该患者明显的或可能罕见的表现，并具有此病相关的如此多的危险因素，我们非常坚信结构性心肌炎诊断，因而导致冠状动脉疾病这种常见的疾病反而被忽视了。

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