一名免疫功能正常的患者因血栓性微血管病并发严重脓毒症。
Severe sepsis caused by complicated by thrombotic microangiopathy in an immunocompetent patient.
作者信息
Maezawa Shota, Kudo Daisuke, Asanuma Keiichiro, Takekoshi Daisuke, Egashira Ryuichiro, Kushimoto Shigeki
机构信息
Department of Emergency and Critical Care MedicineTohoku University Hospital Sendai Japan.
Department of Surgery Osaki Citizen Hospital Osaki Japan.
出版信息
Acute Med Surg. 2016 May 23;4(1):97-100. doi: 10.1002/ams2.222. eCollection 2017 Jan.
CASE
A 61-year-old man with an unremarkable medical history was admitted with fever 7 days after being bitten by his dog. On day 3, he showed altered mental status, and laboratory data showed progressive hemolytic anemia, thrombocytopenia, hyperbilirubinemia, renal dysfunction, coagulopathy, and schistocytosis. Severe sepsis complicated with thrombotic microangiopathy caused by was suspected.
OUTCOME
Plasma exchange was applied to treat the thrombotic microangiopathy and resulted in platelet count increase and improved renal function, hyperbilirubinemia, and schistocytosis. Blood culture results confirmed the presence of . The patient was discharged in good condition.
CONCLUSION
is rare cause of severe sepsis, and should be suspected even in immunocompetent patients with dog-bite history. infection may be complicated by thrombotic microangiopathy, for which plasma exchange should be considered prior to definitive diagnosis of thrombotic microangiopathy.
病例
一名61岁男性，既往病史无特殊，在被狗咬伤7天后因发热入院。第3天，他出现精神状态改变，实验室检查数据显示进行性溶血性贫血、血小板减少、高胆红素血症、肾功能不全、凝血功能障碍和裂体细胞症。怀疑是由严重脓毒症并发血栓性微血管病引起的。
结果
应用血浆置换治疗血栓性微血管病，血小板计数增加，肾功能、高胆红素血症和裂体细胞症得到改善。血培养结果证实存在……。患者康复出院。
结论
……是严重脓毒症的罕见病因，即使在有狗咬伤史的免疫功能正常患者中也应怀疑。……感染可能并发血栓性微血管病，在血栓性微血管病确诊前应考虑进行血浆置换。
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