Covach Adam John, Rose William Nicholas
Department of Pathology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
J Neurol Surg Rep. 2017 Oct;78(4):e123-e124. doi: 10.1055/s-0037-1607280. Epub 2017 Nov 3.
We report a patient who had a working diagnosis of transverse myelitis secondary to a lupus exacerbation. As his clinical course evolved, continued vigilance clarified that he was in fact suffering from a nosocomial infection caused by vancomycin-resistant (VRE). We performed a retrospective review of the patient's medical record. Despite radiographic improvement, he did not improve clinically following immunosuppressive therapy including plasma exchange. Once meningitis was diagnosed and treated, he improved rapidly. The prospect of transverse myelitis may confound the diagnosis of VRE meningitis, a uniquely treated and potentially deadly infection.
我们报告了一名初步诊断为狼疮加重继发横贯性脊髓炎的患者。随着其临床病程的发展,持续的密切观察明确了他实际上是感染了耐万古霉素肠球菌(VRE)引起的医院感染。
我们对该患者的病历进行了回顾性分析。
尽管影像学检查有改善,但在包括血浆置换在内的免疫抑制治疗后,他的临床症状并未改善。一旦诊断并治疗了脑膜炎,他的病情迅速好转。
横贯性脊髓炎的情况可能会混淆VRE脑膜炎的诊断,这是一种治疗方式独特且可能致命的感染。