Silva Clara, Ferrão Diana, Almeida Mariana, Nogueira-Silva Luis, Almeida Jorge S
Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT.
Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, PRT.
Cureus. 2021 Jul 27;13(7):e16662. doi: 10.7759/cureus.16662. eCollection 2021 Jul.
Immune thrombocytopenia (ITP) is a prevalent disease that may need immunosuppressant treatment, which increases the risk of an opportunistic infection. We present the case of a woman with corticosteroid-resistant ITP who was electively admitted to the hospital to initiate second-line treatment. On the second day, she presented with a high fever and altered mental status, with no lesions on the cerebral tomography and inconclusive cerebrospinal fluid analysis. Nonetheless, she was promptly started on empiric antibiotics for meningitis which were then adjusted for , isolated in blood culture. The cerebral magnetic resonance showed signs of cerebritis and pyogenic foci. The patient was discharged after 73 days of treatment, asymptomatic and with no neurological sequelae. The mortality rate of neurolisteriosis can be as high as 50%. The median time between the initial symptoms and their detection is seven days, with many patients already developing cerebral abscesses. The favorable outcome of this patient was due to the precocious detection and start of the treatment.
免疫性血小板减少症（ITP）是一种常见疾病，可能需要免疫抑制治疗，这会增加机会性感染的风险。我们报告一例对皮质类固醇耐药的ITP女性患者，她因需开始二线治疗而择期入院。入院第二天，她出现高热和精神状态改变，脑部断层扫描未发现病变，脑脊液分析结果不明确。尽管如此，她还是立即开始接受针对脑膜炎的经验性抗生素治疗，随后根据血培养结果进行调整。脑部磁共振成像显示有脑炎和化脓性病灶迹象。经过73天的治疗，患者出院，无症状且无神经后遗症。神经型李斯特菌病的死亡率可高达50%。最初症状出现到被发现的中位时间为7天，许多患者此时已发展为脑脓肿。该患者的良好预后得益于早期发现和及时开始治疗。
