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[一名患有威斯科特-奥尔德里奇综合征患者的主动脉瘤]

[Aortic aneurysm in a patient with Wiskott-Aldrich syndrome].

作者信息

García-Domínguez Miguel, De la O-Espinoza Estivaliz Arizel, Cruz-Muñoz Mario

机构信息

Hospital Pediátrico de Sinaloa, Departamento de Inmunología y Alergia, Sinaloa, México.

出版信息

Rev Alerg Mex. 2020 Jan-Mar;67(1):87-93. doi: 10.29262/ram.v67i1.696.

Abstract

BACKGROUND

The Wiskott-Aldrich syndrome is a combined immunodeficiency associated with a syndrome linked to the X chromosome, which is characterized by eczema, recurrent infections, and thrombocytopenia. Other manifestations include autoimmune disorders such as hemolytic anemia or thrombocytopenic purpura mediated by the immune system, increased susceptibility to malignant tumors, including lymphoma or leukemia.

CLINICAL CASE

A 7-year-old male patient with a diagnosis of Wiskott-Aldrich syndrome who was treated with intravenous gamma globulin, antimicrobial prophylaxis with trimethoprim/sulfamethoxazole, and fluconazole, as well as with prednisone and cyclosporine due to hemolytic anemia and uveitis. Suddenly, he presented a deviation of the left labial commissure, so he was hospitalized. The studies showed a giant aneurysm of the aorta root, ascending aorta, descending aorta, and right coronary aorta, with insidious cardiac symptoms; therefore, he was referred to the vascular surgery department.

CONCLUSION

Vasculitis in Wiskott-Aldrich syndrome is rare and it is usually asymptomatic in early stages, so an annual cardiovascular evaluation should be performed in order to avoid the complications of an aneurysm, which can be deleterious in this type of immunodeficiency where the possibility of death from bleeding is high.

摘要

背景

威斯科特-奥尔德里奇综合征是一种与X染色体连锁综合征相关的联合免疫缺陷病,其特征为湿疹、反复感染和血小板减少。其他表现包括自身免疫性疾病,如由免疫系统介导的溶血性贫血或血小板减少性紫癜,以及对恶性肿瘤(包括淋巴瘤或白血病)易感性增加。

临床病例

一名7岁男性患者,诊断为威斯科特-奥尔德里奇综合征,接受了静脉注射丙种球蛋白、用甲氧苄啶/磺胺甲恶唑进行抗菌预防、氟康唑治疗,以及因溶血性贫血和葡萄膜炎使用泼尼松和环孢素治疗。突然,他出现左侧口角歪斜,因此住院治疗。检查显示主动脉根部、升主动脉、降主动脉和右冠状动脉存在巨大动脉瘤,并伴有隐匿性心脏症状;因此,他被转诊至血管外科。

结论

威斯科特-奥尔德里奇综合征中的血管炎较为罕见,早期通常无症状,因此应每年进行心血管评估,以避免动脉瘤并发症,在这种免疫缺陷类型中,动脉瘤并发症可能是有害的,因为出血导致死亡的可能性很高。

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