Sim Benjamin W C, Koo Ray Mun, Hawkins Carolyn, Bowden Francis, Watson Ashley
Infectious Diseases Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Department of Immunology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia Australian National University (ANU) Medical School, Canberra, Australian Capital Territory, Australia.
BMJ Case Rep. 2015 Jan 7;2015:bcr2014206091. doi: 10.1136/bcr-2014-206091.
A 57-year-old man with type II mixed cryoglobulinaemia presented to the emergency department with a history of worsening lethargy, malaise and non-drenching night sweats in a relapsing-remitting pattern. He was diagnosed with type II mixed cryoglobulinaemia 7 months ago following episodes of fever, night sweats, lethargy and malaise associated with a non-blanching, purpuric, raised erythematous rash that responded partially to immunosuppressive therapy and short courses of oral antibiotics. A single blood culture then yielded Granulicatella adiacens which was reported as a possible contaminant and therefore, not pursued. Despite numerous other investigations, the underlying cause of his type II cryoglobulinaemia remained undetermined. On his current presentation, the physical examination revealed signs of infective endocarditis. Two further blood cultures grew G. adiacens. The diagnosis of infective endocarditis was established on a transoesophageal echocardiography, and the subsequent antibiotic and surgical therapy resulted in complete remission of his type II mixed cryoglobulinaemia.
一名57岁的II型混合性冷球蛋白血症男性患者因病情反复加重出现嗜睡、不适和非盗汗性夜间盗汗，前往急诊科就诊。7个月前，他在出现发热、盗汗、嗜睡和不适，并伴有非压褪色的紫癜性红斑皮疹后，被诊断为II型混合性冷球蛋白血症，该皮疹对免疫抑制治疗和短期口服抗生素治疗有部分反应。当时一次血培养分离出毗邻颗粒链菌，报告认为可能是污染物，因此未进一步追查。尽管进行了许多其他检查，其II型冷球蛋白血症的根本病因仍未明确。此次就诊时，体格检查发现了感染性心内膜炎的体征。另外两次血培养分离出毗邻颗粒链菌。经食管超声心动图检查确诊为感染性心内膜炎，随后的抗生素和手术治疗使他的II型混合性冷球蛋白血症完全缓解。
