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川崎病患者并发毛细血管渗漏综合征和无菌性脑膜炎:一例报告

Capillary leak syndrome and aseptic meningitis in a patient with Kawasaki disease: A case report.

作者信息

Zhang Yufeng, Wan Han, Du Maosheng, Deng Huiling, Fu Jia, Zhang Yu, Wang Xiaoyan, Liu Ruiqing

机构信息

Second Department of Infectious Diseases, Xi'an Children's Hospital Department of Hepatobiliary Surgery, The 521 Hospital of China Ordnance Industry Outpatient Office, Xi'an Children's Hospital, Xi'an, Shaanxi Province, China.

出版信息

Medicine (Baltimore). 2018 Jun;97(23):e10716. doi: 10.1097/MD.0000000000010716.

Abstract

RATIONALE

Kawasaki disease (KD) is an acute vasculitis of childhood, coronary complications are the most serious and classic complications of this disease. However, simultaneous complications such as systemic capillary leak syndrome (CLS) and aseptic meningitis are rarely reported.

PATIENT CONCERNS

A 19-month-old boy had continuous fever for 6 days, rash for 3 days, and somnolence for 1 day.

DIAGNOSES

The boy was diagnosed with KD presenting with SCLS and aseptic meningitis.

INTERVENTIONS

He was treated with gamma globulin (2 g/kg) for 1 day, mannitol and furosemide to reduce intracranial pressure, human albumin to correct hypoproteinemia, methylprednisolone to control inflammation, and both aspirin and dipyridamole for anticoagulation.

OUTCOMES

After treatment, the patient recovered well. At one year follow-up, the patient was asymptomatic and showed no recurrence of skin rash.

LESSONS

The incidence of KD has recently increased and cardiovascular complications are frequently reported. This may be combined with systemic damage, however, the combination of SCLS and aseptic meningitis is rarely reported, therefor, children who have SCLS, aseptic meningitis and unexplained fever >5 days, KD should be taken into account. Early diagnosis and timely treatment can reduce complications induced by KD.

摘要

理论依据

川崎病(KD)是一种儿童急性血管炎,冠状动脉并发症是该疾病最严重且典型的并发症。然而,诸如全身性毛细血管渗漏综合征(CLS)和无菌性脑膜炎等同时出现的并发症鲜有报道。

患者情况

一名19个月大的男孩持续发热6天、出疹3天、嗜睡1天。

诊断结果

该男孩被诊断为患有川崎病并伴有全身性毛细血管渗漏综合征和无菌性脑膜炎。

干预措施

他接受了1天的静脉注射丙种球蛋白(2g/kg)治疗,使用甘露醇和呋塞米降低颅内压,用人血白蛋白纠正低蛋白血症,用甲泼尼龙控制炎症,并用阿司匹林和双嘧达莫进行抗凝治疗。

治疗结果

治疗后,患者恢复良好。在一年的随访中,患者无症状且未出现皮疹复发。

经验教训

川崎病的发病率最近有所上升,心血管并发症屡有报道。该病可能伴有全身性损害,然而,全身性毛细血管渗漏综合征和无菌性脑膜炎同时出现的情况鲜有报道,因此,对于患有全身性毛细血管渗漏综合征、无菌性脑膜炎且不明原因发热超过5天的儿童,应考虑川崎病。早期诊断和及时治疗可减少川崎病引发的并发症。

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