一名成人T细胞白血病患者因巨细胞病毒感染导致回肠穿孔。
Ileum perforation due to cytomegalovirus infection in a patient with adult T-cell leukemia.
作者信息
Nishimura Takeshi, Nakao Atsunori, Okamoto Ayana, Kihara Takako, Hirota Seiichi, Fujisaki Noritomo, Kotani Joji
机构信息
Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Hyogo Japan.
Department of Surgical Pathology Hyogo College of Medicine Nishinomiya Hyogo Japan.
出版信息
Acute Med Surg. 2015 Aug 27;3(2):178-181. doi: 10.1002/ams2.145. eCollection 2016 Apr.
CASE
A 73-year-old woman was transferred to our department due to severe abdominal pain with peritonitis. Her laboratory data showed that her white blood cell count was elevated to more than 50,000/mm. Antibodies to HTLV-I were positive and we made the diagnosis of adult T-cell leukemia (ATL).
OUTCOME
Emergency laparotomy was performed and revealed two separate small perforations of the ileum, requiring bowel resection. Immunohistochemistry for cytomegalovirus (CMV) antigen revealed positive staining in the intestinal stromal cells. Despite surgery and antiviral therapy with ganciclovir, she died after 28 days.
CONCLUSION
Adult T-cell leukemia patients may present acute abdominal pain due to intestinal perforation caused by CMV infection. We should be aware of CMV infection as one of the pathogens causing acute abdominal crises such as massive hemorrhage or visceral perforation.
病例
一名73岁女性因严重腹痛伴腹膜炎转入我科。她的实验室检查数据显示白细胞计数升高至超过50,000/mm³。人类嗜T淋巴细胞病毒I型（HTLV-I）抗体呈阳性，我们诊断为成人T细胞白血病（ATL）。
结果
进行了急诊剖腹手术，发现回肠有两个独立的小穿孔，需要进行肠切除。巨细胞病毒（CMV）抗原的免疫组织化学检查显示肠道基质细胞呈阳性染色。尽管进行了手术并使用更昔洛韦进行抗病毒治疗，但她在28天后死亡。
结论
成人T细胞白血病患者可能因CMV感染导致肠道穿孔而出现急性腹痛。我们应将CMV感染视为引起急性腹部危象（如大出血或内脏穿孔）的病原体之一。
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