Kazi S, Preston G C
Department of Haematology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, UK,
Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK.
J R Coll Physicians Edinb. 2018 Jun;48(2):127-129. doi: 10.4997/JRCPE.2018.206.
Thrombotic microangiopathy is a rare but serious manifestation of a variety of diseases. The key features are microangiopathic haemolysis, thrombocytopaenia, renal dysfunction and neurological symptoms. Here we discuss the case of a previously well male presenting with community-acquired pneumonia who developed thrombotic microangiopathy during admission. This case illustrates the difficulties in the differential diagnosis and reminds us of the importance of the peripheral blood film in identifying the cause of thrombocytopaenia. One life-threatening cause of thrombotic microangiopathy is thrombotic thrombocytopaenia purpura and when that diagnosis is suspected emergency plasma exchange is essential. Many drugs can cause thrombotic microangiopathy and here we highlight the commonly-prescribed antibiotic levofloxacin as the culprit.
血栓性微血管病是多种疾病罕见但严重的表现形式。其关键特征为微血管病性溶血、血小板减少、肾功能不全及神经症状。在此，我们讨论一例既往健康的男性患者，因社区获得性肺炎入院，住院期间发生血栓性微血管病。该病例说明了鉴别诊断的困难，并提醒我们外周血涂片在确定血小板减少原因方面的重要性。血栓性微血管病的一个危及生命的病因是血栓性血小板减少性紫癜，当怀疑该诊断时，紧急血浆置换至关重要。许多药物可导致血栓性微血管病，在此我们强调常用抗生素左氧氟沙星是罪魁祸首。
