落基山斑疹热治疗期间的持续性脑血管炎
Ongoing Cerebral Vasculitis During Treatment of Rocky Mountain Spotted Fever.
作者信息
Sun Lisa R, Huisman Thierry A G M, Yeshokumar Anusha K, Johnston Michael V
机构信息
Division of Pediatric Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
出版信息
Pediatr Neurol. 2015 Nov;53(5):434-8. doi: 10.1016/j.pediatrneurol.2015.07.003. Epub 2015 Jul 22.
BACKGROUND
Rocky Mountain spotted fever is a tickborne infection that produces a systemic small-vessel vasculitis; its prognosis is excellent if appropriate treatment is initiated early. Because the advent of effective antirickettsial therapies predates the widespread use of brain magnetic resonance imaging, there are limited data on the effect of untreated Rocky Mountain spotted fever infection on neuroimaging studies.
PATIENT DESCRIPTION
We describe a 7-year-old girl with delayed treatment of Rocky Mountain spotted fever who suffered severe neurological impairment. Serial brain magnetic resonance images revealed a progressive "starry sky appearance," which is proposed to result from the same small vessel vasculitis that causes the characteristic skin rash of this infection.
CONCLUSION
Neurological injury can continue to occur despite specific antirickettsial therapy in Rocky Mountain spotted fever. This child's clinical features raise questions about the optimal management of this infection, particularly the utility of immune modulating therapies in cases of delayed treatment and neurological involvement.
背景
落基山斑疹热是一种由蜱传播的感染性疾病，可引发全身性小血管血管炎；若早期开始适当治疗，其预后良好。由于有效的抗立克次体疗法出现的时间早于脑磁共振成像的广泛应用，关于未经治疗的落基山斑疹热感染对神经影像学研究影响的数据有限。
患者描述
我们报告一名7岁女童，因落基山斑疹热治疗延误而出现严重神经功能损害。系列脑磁共振图像显示出一种进行性的“星空外观”，推测这是由导致该感染特征性皮疹的相同小血管血管炎引起的。
结论
尽管针对落基山斑疹热进行了特异性抗立克次体治疗，但神经损伤仍可能继续发生。该患儿的临床特征引发了关于这种感染最佳治疗方案的疑问，特别是在治疗延误和出现神经受累的情况下免疫调节疗法的效用。
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