Arning M, Aul C, Reinecke P, Bürrig K F, Schneider W
Abteilung für Hämatologie, Onkologie und klinische Immunologie, Universität Düsseldorf.
Dtsch Med Wochenschr. 1990 Oct 19;115(42):1591-5. doi: 10.1055/s-2008-1065196.
A 25-year-old man, known to have chronic myeloid leukaemia for four years, acutely developed a fever of 39.5 degrees and severe pain in the shoulder and hip joints. There was no evidence of joint disease. Treatment with indomethacin briefly improved the symptoms, but within 72 hours the patient developed a fulminant illness with high fever and clinical as well as biochemical signs of a severe consumption coagulopathy. Herpetiform efflorescences appeared over the head and trunk shortly before death. At autopsy there was histological and immunohistochemical evidence of a varicella infection with hepatitis, oesophageal involvement and severe internal organ bleedings. In immune-compromised patients with atypical prodromal symptoms a varicella infection must be considered so that causal treatment with acyclovir and hyperimmune-globulin can be begun in time.
一名25岁男性，患慢性粒细胞白血病已四年，突然出现39.5度高烧以及肩部和髋关节剧痛。无关节疾病证据。使用吲哚美辛治疗后症状短暂改善，但72小时内患者病情急剧恶化，出现高烧以及严重消耗性凝血病的临床和生化体征。死亡前不久，头部和躯干出现疱疹样皮疹。尸检发现有组织学和免疫组化证据表明存在水痘感染，并伴有肝炎、食管受累和严重内脏出血。对于有非典型前驱症状的免疫功能低下患者，必须考虑水痘感染，以便及时开始使用阿昔洛韦和高效价免疫球蛋白进行病因治疗。
