Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Haematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Immunobiology. 2021 May;226(3):152075. doi: 10.1016/j.imbio.2021.152075. Epub 2021 Mar 2.
Cold agglutinin disease (CAD) is extremely rare in children. We report an 8-year-old boy who presented with gangrene of right foot with hypertension and absent lower limb pulses. Blood peripheral smear evidence of autoagglutination and falsely elevated red blood cell indices were suggestive of CAD and on subsequent investigations he was found to have high titres of cold agglutinin antibodies. He also had evidence of pneumonia on chest X-ray and serology for mycoplasma was positive. Computed tomography angiography showed multifocal thrombotic occlusion in bilateral popliteal arteries. He was effectively managed using antimicrobials, warm clothing, aspirin, anticoagulation and corticosteroids. He remains clinically well on follow-up and had no recurrence. CAD presenting with peripheral gangrene is extremely unusual. A careful look at peripheral blood smear gives an initial diagnostic clue. CAD triggered by infection is often self-limiting and requires supportive care.
冷凝集素病（CAD）在儿童中极为罕见。我们报告了一例 8 岁男孩，他因右脚坏疽、高血压和下肢无脉搏就诊。外周血涂片存在自身凝集证据和红细胞指数假性升高提示 CAD，进一步检查发现他的冷凝集素抗体滴度很高。他的胸片也有肺炎的证据，支原体血清学检查呈阳性。计算机断层血管造影显示双侧腘动脉多发性血栓闭塞。他通过使用抗生素、保暖衣物、阿司匹林、抗凝和皮质类固醇治疗得到有效管理。在随访中他的病情仍然稳定，没有复发。CAD 表现为周围性坏疽极为罕见。仔细观察外周血涂片可提供初步诊断线索。由感染引起的 CAD 通常是自限性的，需要支持性治疗。
