Walker D H, Parks F M, Betz T G, Taylor J P, Muehlberger J W
Department of Pathology, University of Texas Medical Branch, Galveston 77550.
Am J Clin Pathol. 1989 Jun;91(6):720-4. doi: 10.1093/ajcp/91.6.720.
An 81-year-old woman had chills, fever, nausea, vomiting, and epigastric pain. On day 3 she had hematuria and was treated with trimethoprim-sulfamethoxazole. On day 5 she had a cough, hypotension, anemia, azotemia, and elevated hepatic enzyme levels. Her condition deteriorated with thrombocytopenia, anuria requiring dialysis, edema, and hypoalbuminemia. Treatment with chloramphenicol and doxycycline was started on day 10. By day 11, she was in hypotensive shock; on day 12 she had seizures and died. Murine typhus was diagnosed by demonstration of antibodies to Rickettsia typhi by indirect immunofluorescence. Necropsy revealed interstitial pneumonia, pulmonary edema, hyaline membranes, alveolar hemorrhages, petechiae and vasculitis in the central nervous system, interstitial myocarditis, multifocal interstitial nephritis and hemorrhages, splenomegaly, portal triaditis, and mucosal hemorrhages in urinary tract. Immunofluorescent R. typhi were demonstrated in the lungs, brain, kidneys, liver, and heart. This unusual death occurred in an elderly patient without rash who was treated too late with antirickettsial drugs.
一名81岁女性出现寒战、发热、恶心、呕吐及上腹部疼痛。第3天出现血尿，接受了甲氧苄啶 - 磺胺甲恶唑治疗。第5天出现咳嗽、低血压、贫血、氮质血症及肝酶水平升高。她的病情恶化，出现血小板减少、需透析的无尿、水肿及低白蛋白血症。第10天开始用氯霉素和强力霉素治疗。到第11天，她处于低血压休克状态；第12天出现癫痫发作并死亡。通过间接免疫荧光法检测到抗斑疹伤寒立克次体抗体，从而诊断为鼠型斑疹伤寒。尸检显示间质性肺炎、肺水肿、透明膜、肺泡出血、中枢神经系统瘀点及血管炎、间质性心肌炎、多灶性间质性肾炎及出血、脾肿大、门三联炎以及泌尿道黏膜出血。在肺、脑、肾、肝和心脏中发现了荧光免疫法检测的斑疹伤寒立克次体。这例不寻常的死亡发生在一名老年患者身上，该患者无皮疹，且抗立克次体药物治疗过晚。
