Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan.
Emerg Med Australas. 2012 Oct;24(5):577-80. doi: 10.1111/j.1742-6723.2012.01600.x.
Scrub typhus is an infectious disease that is caused by Orientia tsutsugamushi. The authors describe an autopsied case of scrub typhus complicated with severe disseminated intravascular coagulation (DIC). An 82-year-old man complained of fever 4 days after climbing a mountain. The patient was admitted to an urban hospital, and meropenem and ceftriaxone were administered. The patient's condition deteriorated and he was transferred to a second hospital. On physical examination, a black scab was found and scrub typhus was suspected. Despite intensive treatment, the patient died on the fifth day. High levels of O. tsutsugamushi IgM antibody were confirmed. An autopsy revealed systemic vasculitis and perivasculitis. The endothelial tissue of the white pulp of the spleen was markedly infiltrated by plasma cells. The authors speculated that a severe immune reaction against O. tsutsugamushi enhanced an inflammatory response, leading to DIC. This case is a warning to doctors who are not familiar with scrub typhus.
恙虫病是由恙虫病东方体引起的传染病。作者描述了一例恙虫病并发严重弥散性血管内凝血（DIC）的尸检病例。一名 82 岁男性在登山 4 天后出现发热。患者被收入城市医院，并给予美罗培南和头孢曲松治疗。患者病情恶化，转至第二家医院。体格检查发现一处黑色痂皮，怀疑为恙虫病。尽管进行了强化治疗，患者还是在第五天死亡。检测到恙虫病东方体 IgM 抗体水平升高。尸检显示全身血管炎和血管周炎。脾脏白髓的内皮组织明显被浆细胞浸润。作者推测针对恙虫病东方体的严重免疫反应增强了炎症反应，导致 DIC。这个病例提醒那些不熟悉恙虫病的医生注意。
