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犬噬细胞性综合征伴严重败血症,由嗜吞噬细胞无形体引起。

Hemophagocytic syndrome with severe sepsis caused by Capnocytophaga canimorsus.

机构信息

Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.

Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.

出版信息

Am J Emerg Med. 2020 Jul;38(7):1540.e5-1540.e8. doi: 10.1016/j.ajem.2020.03.017. Epub 2020 Mar 12.

Abstract

Capnocytophaga canimorsus, commonly transmitted by dog bites, can cause severe sepsis, and the mortality rate is very high. We experienced a case of hemophagocytic lymphohistiocytosis (HLH) complicated by severe sepsis caused by C. canimorsus. A 58-year-old man with no remarkable medical history was admitted to another hospital with fever and mild consciousness disorder developed 3 days after being bitten by his dog. The next day, the patient developed disseminated intravascular coagulation and shock and was transferred to our emergency medical center. Blood tests showed hyperferritinemia and cytopenia, and bone marrow aspiration was performed. As a result, we diagnosed severe sepsis and HLH. Once antibiotic and steroid therapy was started, the patient's infection and cytopenia improved. Unfortunately, the patient's fingers and toes required amputation, but his life was saved, and he was discharged from hospital. Because HLH may be hidden in such cases, it may be necessary to measure serum ferritin and perform bone marrow aspiration if hyperferritinemia is suspected.

摘要

贪噬细胞菌(Capnocytophaga canimorsus)通常通过狗咬伤传播,可引起严重败血症,死亡率非常高。我们遇到了一例由贪噬细胞菌引起的噬血细胞性淋巴组织细胞增生症(HLH)并发严重败血症的病例。一位 58 岁的男性,无明显病史,在被狗咬伤 3 天后出现发热和轻度意识障碍,被收入另一家医院。第二天,患者出现弥漫性血管内凝血和休克,并被转至我们的急诊医学中心。血液检查显示铁蛋白血症和血细胞减少症,进行了骨髓抽吸。因此,我们诊断为严重败血症和 HLH。一旦开始使用抗生素和类固醇治疗,患者的感染和血细胞减少症得到改善。不幸的是,患者的手指和脚趾需要截肢,但他的生命得以挽救,并出院。因为噬血细胞性淋巴组织细胞增生症可能隐藏在这种情况下,所以如果怀疑铁蛋白血症,可能需要测量血清铁蛋白并进行骨髓抽吸。

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