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小儿EB病毒感染伴发面瘫1例

2018-05-10 朱其国 陈競芳 林小辛 临床儿科杂志

2岁男孩,2016年6月8日因“发热伴口角歪斜4天”收住厦门市儿童医院。

【一般资料】

2岁男孩,

【主诉】

2016年6月8日因“发热伴口角歪斜4天”收住厦门市儿童医院。

【体格检查】

精神状态良好,全身未见皮疹,双眼睑略有浮肿,颈部淋巴结轻度肿大,扁桃体Ⅱ度肿大伴白色分泌物,口腔未见疱疹,心、肺无殊,肝、脾无明显肿大,双下肢未见浮肿,右侧前额运动减少、眉略下垂、闭眼困难、鼻唇沟消失,嘴角偏向左侧。

【辅助检查】

外周血白细胞总数14.69×109/L,淋巴细胞60.7%,中性粒细胞29.1%,C反应蛋白<1mg/L,外周血涂片淋巴细胞70%,中性粒细胞20%,异常淋巴细胞10%;谷氨酸转氨酶16U/L,天冬氨酸转氨酶30U/L,乳酸脱氢酶352U/L,血沉46mm/h,α羟丁酸脱氢酶342U/L,肌酸激酶同功酶21U/L,肌酸激酶21U/L。EBV血清学抗体:抗病毒衣壳IgM抗体(VCA-IgM)阳性,抗病毒衣壳抗体IgG(VCA-IgG)阳性,抗早期抗原抗体IgG(EA-IgG)阴性,抗核抗原抗体IgG(NA-IgG)阴性;血浆EBV-DNA阳性,血浆CMV-DNA阴性,CMV-IgM抗体阳性。单纯疱疹病毒Ⅰ型和Ⅱ型血清IgM抗体均阴性。五官科会诊除外中耳炎。家属拒绝头颅CT和腰椎穿刺检查。脑电图正常。

【治疗】

入院后予以阿昔洛韦每次5mg/kg,q8h静脉给药治疗,入院第3天起患儿体温恢复正常,之后针灸辅助治疗,面瘫逐渐好转,静脉用药7天后,于2016年6月19日出院,出院后继续口服阿昔洛韦治疗1周,每周门诊随访,出院1周后复查血浆EBV-DNA阴性。出院后随访6周,面瘫症状全部消失,外周血象均正常。

原始出处:

朱其国, 陈競芳, 林小辛,等. 儿童EB病毒感染伴面瘫1例报告并文献复习[J]. 临床儿科杂志, 2017, 35(7):516-518.

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    2018-10-30 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

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    2018-05-14 秀红

    学习了

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=350929, encodeId=d2c435092949, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Oct 30 07:53:17 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314862, encodeId=026c3148620b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Mon May 14 00:17:17 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533793, encodeId=82b11533e935a, content=<a href='/topic/show?id=47be64e04a' target=_blank style='color:#2F92EE;'>#EB病毒感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6470, encryptionId=47be64e04a, topicName=EB病毒感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=88ea12488352, createdName=zchen, createdTime=Sat May 12 11:34:00 CST 2018, time=2018-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314191, encodeId=dd84314191b0, content=很好.积极学习临床病例报道, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri May 11 18:51:53 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314020, encodeId=4e003140200e, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Yjl9B4uRHNDYyv8h54lSAKQrN8Hm0CNTrbfJsria8mC1g807WBkjAZTn4uFTbp38VvJXtWEDuzXNjPFbO4m7Cvg/132, createdBy=06a21658853, createdName=1dde4494m54(暂无匿称), createdTime=Fri May 11 06:52:43 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314015, encodeId=9f303140150e, content=木有糖皮质激素治疗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Fri May 11 06:48:12 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313933, encodeId=ad2e313933cf, content=入院后予以阿昔洛韦每次5mg/kg.q8h静脉给药治疗.入院第3天起患儿体温恢复正常.之后针灸辅助治疗.面瘫逐渐好转.静脉用药7天后.于2016年6月19日出院.出院后继续口服阿昔洛韦治疗1周.每周门诊随访.出院1周后复查血浆EBV-DNA阴性.出院后随访6周.面瘫症状全部消失.外周血象均正常., beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 10 23:03:25 CST 2018, time=2018-05-10, status=1, ipAttribution=)]
    2018-05-11 虈亣靌

    很好.积极学习临床病例报道

    0

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    2018-05-11 1dde4494m54(暂无匿称)

    不错

    0

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    2018-05-11 baihao215

    木有糖皮质激素治疗?

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=350929, encodeId=d2c435092949, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Oct 30 07:53:17 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314862, encodeId=026c3148620b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Mon May 14 00:17:17 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533793, encodeId=82b11533e935a, content=<a href='/topic/show?id=47be64e04a' target=_blank style='color:#2F92EE;'>#EB病毒感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6470, encryptionId=47be64e04a, topicName=EB病毒感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=88ea12488352, createdName=zchen, createdTime=Sat May 12 11:34:00 CST 2018, time=2018-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314191, encodeId=dd84314191b0, content=很好.积极学习临床病例报道, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri May 11 18:51:53 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314020, encodeId=4e003140200e, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Yjl9B4uRHNDYyv8h54lSAKQrN8Hm0CNTrbfJsria8mC1g807WBkjAZTn4uFTbp38VvJXtWEDuzXNjPFbO4m7Cvg/132, createdBy=06a21658853, createdName=1dde4494m54(暂无匿称), createdTime=Fri May 11 06:52:43 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=314015, encodeId=9f303140150e, content=木有糖皮质激素治疗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Fri May 11 06:48:12 CST 2018, time=2018-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313933, encodeId=ad2e313933cf, content=入院后予以阿昔洛韦每次5mg/kg.q8h静脉给药治疗.入院第3天起患儿体温恢复正常.之后针灸辅助治疗.面瘫逐渐好转.静脉用药7天后.于2016年6月19日出院.出院后继续口服阿昔洛韦治疗1周.每周门诊随访.出院1周后复查血浆EBV-DNA阴性.出院后随访6周.面瘫症状全部消失.外周血象均正常., beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu May 10 23:03:25 CST 2018, time=2018-05-10, status=1, ipAttribution=)]
    2018-05-10 有备才能无患

    入院后予以阿昔洛韦每次5mg/kg.q8h静脉给药治疗.入院第3天起患儿体温恢复正常.之后针灸辅助治疗.面瘫逐渐好转.静脉用药7天后.于2016年6月19日出院.出院后继续口服阿昔洛韦治疗1周.每周门诊随访.出院1周后复查血浆EBV-DNA阴性.出院后随访6周.面瘫症状全部消失.外周血象均正常.

    0

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