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NEJM:播散性水痘感染-病例报道

2019-09-12 xing.T MedSci原创

根据他与水痘患者的接触史,以及存在免疫抑制情况下的病变和肺部症状,进行了播散性水痘感染的临床诊断。

患者为一名有再生障碍性贫血病史的29岁男性,正在接受环孢菌素治疗,他因发热、咳嗽和静息时呼吸困难4天而在急诊就诊。在症状出现前一天,他的脸部、躯干和四肢出现了瘙痒性皮疹。

体格检查时,脉搏为每分钟104次,血压为110/70 mmHg,呼吸频率为每分钟36次呼吸,当患者吸入高流量氧气时,血氧饱和度为90%。他在不同发育阶段出现弥漫性皮疹,包括丘疹、水疱、脓疱和结痂囊泡(如图A所示)。实验室检查发现血小板计数为每立方毫米33000(参考范围为150000至400000),丙氨酸氨基转移酶水平为297 U/L(参考范围为2至41),天冬氨酸氨基转移酶水平为281 U/L(参考范围为2到40)。胸部X线片显示多个结节聚集形成结节性实变并在两肺中浸润(如图B所示)。



根据他与水痘患者的接触史,以及存在免疫抑制情况下的病变和肺部症状,进行了播散性水痘感染临床诊断

尽管治疗包括静脉注射阿昔洛韦,机械通气以及急性呼吸窘迫综合征方案,患者在就诊后2天死亡。 

原始出处:

Ashok K. Pannu,et al.Disseminated Varicella Infection.N Engl J Med 2019;https://www.nejm.org/doi/full/10.1056/NEJMicm1814626

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    2019-09-12 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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