一名合并肺结核、表现为严重难治性贫血和吞咽困难的年轻男性Plummer-Vinson综合征：一例罕见病例报告

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中文摘要

背景： Plummer-Vinson综合征（PVS）是一种罕见的临床疾病，以缺铁性贫血（IDA）、吞咽困难和上段食管蹼三联征为特征。它主要影响中年女性，在年轻男性中不常见。方法：我们报告一例24岁男性患者，主诉逐渐进展的吞咽困难和反复严重贫血，需要多次输血。临床检查发现苍白、口角炎和舌炎。实验室检查显示严重的微细胞低色素性贫血，血清铁蛋白和铁水平降低，提示IDA伴炎症成分。影像学检查，包括增强计算机断层扫描和钡餐吞咽，发现上段食管蹼。上消化道内镜确认颈段食管狭窄，并成功用Savary-Gilliard探条扩张治疗。进一步评估发现肺结核（TB），支气管肺泡灌洗液在盒式核酸扩增检测中结核分枝杆菌阳性。结果：患者接受内镜下扩张、口服铁补充和抗结核治疗，随访中吞咽困难完全缓解，血液学显著改善。结论：本病例强调诊断PVS并评估贫血原因而非对症治疗患者的重要性，以及在出现非典型主诉的患者中考虑肺结核诊断，并强调其作为慢性炎症性疾病在加重缺铁和慢性病贫血中的作用。早期识别和及时多学科管理对于防止诊断延迟、缓解症状和改善结局至关重要。

英文摘要

Plummer-Vinson syndrome (PVS) is a rare clinical condition characterized by the triad of iron deficiency anemia (IDA), dysphagia, and upper esophageal web. It predominantly affects middle-aged females and is uncommon in young males. We report the case of a 24-year-old male patient presenting with complaints of gradually progressive dysphagia and recurrent severe anemia, which required multiple blood transfusions. Clinical examination revealed pallor, angular cheilitis, and glossitis. Laboratory investigations showed severe microcytic hypochromic anemia with reduced serum ferritin and iron levels, suggesting IDA with an inflammatory component. Radiological testing, including contrast-enhanced computed tomography and barium swallow, identified an upper esophageal web. Upper gastrointestinal endoscopy confirmed cervical esophageal narrowing, which was successfully treated with Savary-Gilliard bougie dilatation. Further evaluation revealed pulmonary tuberculosis (TB) with bronchoalveolar lavage positive for Mycobacterium tuberculosis on cartridge-based nucleic acid amplification test. The patient was managed with endoscopic dilatation, oral iron supplementation, and antitubercular therapy, resulting in complete resolution of dysphagia and significant hematologic improvement on follow-up. This case highlights the importance of diagnosing PVS and evaluating for the cause of anemia rather than treating the patient symptomatically and considering pulmonary TB as a diagnosis in patients who present with atypical complaints and emphasizes its role as a chronic inflammatory disease in aggravating iron deficiency and anemia of chronic disease. Early recognition and prompt multidisciplinary management are essential to prevent diagnostic delay, alleviate symptoms, and improve outcome.