罕见的继发性噬血细胞淋巴组织细胞增生症病因：全身美洲大蠊中毒。
A rare cause of secondary hemophagocytic lymphohistiocytosis: systemic loxoscelism.
机构信息
Divisions of Pediatric Infectious Diseases,Ankara University Faculty of Medicine, Ankara, Turkey.
Department of Pediatrcis, Ankara University Faculty of Medicine, Ankara, Turkey.
出版信息
Turk J Pediatr. 2020;62(4):641-646. doi: 10.24953/turkjped.2020.04.014.
BACKGROUND
Loxoscelism is caused by the bite of a specific spider type called the Loxosceles genus. In Turkey, most cases are seen after L. rufescens bites. Clinical manifestation of the bites ranges from local cutaneous reaction to severe ulcerative necrosis. Systemic loxoscelism may also occur.
CASE
Herein, we report a previously healthy five-year-old male patient who developed a secondary hemophagocytic lymphohistiocytosis after a presumed brown spider bite. He was treated with dexamethasone. Within the following 14 days, hemophagocytic syndrome resolved. Local hyperbaric oxygen therapy was applied to the necrotic areas.
CONCLUSION
Secondary hemophagocytic lymphohistiocytosis may develop after systemic loxoscelism. In the presence of persistent fever, hepatosplenomegaly and laboratory findings this clinical entity should be kept in mind.
背景
裂颊蛛咬伤会导致裂体属（Loxosceles）的特定蜘蛛类型引发裂体（洛克斯）病。在土耳其，大多数病例是由红背蜘蛛咬伤引起的。咬伤的临床表现从局部皮肤反应到严重的溃疡性坏死不等。全身性裂体病也可能发生。
病例
本文报告了一例此前健康的 5 岁男性患者，他在疑似棕色蜘蛛咬伤后发生了继发性噬血细胞性淋巴组织细胞增生症。他接受了地塞米松治疗。在接下来的 14 天内，噬血细胞综合征得到缓解。坏死区域接受了局部高压氧治疗。
结论
全身性裂体病后可能会发生继发性噬血细胞性淋巴组织细胞增生症。在持续发热、肝脾肿大和实验室检查结果存在的情况下，应考虑到这种临床情况。
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