Varadarajan Indumathy, Pham Natalie, Ballen Karen
Department of Hematology Oncology, University of Virginia Medical Center, Charlottesville, VA, USA.
Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, VA, USA.
Case Rep Oncol. 2024 Oct 29;17(1):1246-1251. doi: 10.1159/000541338. eCollection 2024 Jan-Dec.
Purpura fulminans is a rare but fatal manifestation of bacteremia that can present in immunocompromised hosts. This can have a profound impact on patients, including recipients of allogeneic hematopoietic stem cell transplant. Despite aggressive therapy, mortality can be as high as 60% and most patients require amputation of multiple extremities.
We present a 31-year-old woman s/p myeloablative allogeneic transplant, presenting with purpura fulminans and septic shock. She had been on Immunosuppressive therapy with rituximab and tacrolimus. Despite aggressive antibiotic coverage and supportive therapy, although her shock was resuscitated, she had to undergo bilateral below-knee amputations.
We attempt to highlight the clinical presentation, pathophysiology and potential therapeutic options for immunocompromised patients presenting with septic shock from . The importance of pre-transplant counselling on handling and adoption of new pets to prevent zoonotic infections is also discussed. Early recognition and initiation of antibiotics play a crucial role to reduce mortality in patients receiving HSCT.
暴发性紫癜是菌血症的一种罕见但致命的表现，可出现在免疫功能低下的宿主中。这会对患者产生深远影响，包括异基因造血干细胞移植受者。尽管进行了积极治疗，死亡率仍可高达60%，大多数患者需要截肢多个肢体。
我们报告一名31岁女性，在接受清髓性异基因移植后，出现暴发性紫癜和感染性休克。她一直在接受利妥昔单抗和他克莫司的免疫抑制治疗。尽管给予了积极的抗生素治疗和支持治疗，虽然她的休克得到了复苏，但她不得不接受双侧膝下截肢手术。
我们试图强调免疫功能低下患者出现感染性休克的临床表现、病理生理学和潜在治疗选择。还讨论了移植前咨询在处理和收养新宠物以预防人畜共患感染方面的重要性。早期识别和使用抗生素对于降低接受造血干细胞移植患者的死亡率起着至关重要的作用。
