发热、头痛、皮肤紫癜2例

发布时间：2018-04-08 21:00

本文选题：发热　切入点：头痛　出处：《中国当代儿科杂志》2017年09期

【摘要】：该研究2例学龄期患儿于春季急性起病,表现为发热、头痛、呕吐、意识障碍,以及皮肤紫癜、脑膜刺激征阳性。外周血白细胞及中性粒细胞均增高、血红蛋白及血小板不同程度降低;CRP明显增高;脑脊液白细胞数增高达数百或上千、且以中性粒细胞为主,脑脊液蛋白增高,糖、氯化物正常。其中1例头颅CT示右侧小脑、双侧大脑多发血肿。骨髓细胞学提示感染性骨髓象,血培养、骨髓培养均提示金黄色葡萄球菌(MRSA)。患儿抗感染治疗过程中出现心脏杂音,并且血红蛋白及血小板进行性下降,心脏彩超发现主动脉瓣赘生物形成,确诊为感染性心内膜炎(IE)。根据药敏试验改为万古霉素抗感染治疗,1例6周后痊愈,1例放弃治疗死亡。儿童IE起病隐匿,临床表现多样,建议对于不明原因发热患儿要注意动态观察心脏杂音,及时行心脏彩超排除IE;以化脑为表现的患儿伴有难以用血小板减少解释的皮肤、黏膜出血时,也应警惕IE。
[Abstract]:In this study, 2 school-age children developed acute onset in spring with fever, headache, vomiting, disturbance of consciousness, skin purpura and positive meningeal irritation sign.WBC and neutrophilic granulocytes in peripheral blood increased, hemoglobin and platelet decreased in varying degrees, CRP increased significantly, the number of leukocytes in cerebrospinal fluid increased as high as hundreds or thousands, and mainly neutrophil, cerebrospinal fluid protein increased, glucose,The chloride is normal.In one case, the right cerebellum was shown on CT scan and multiple hematomas were found in both sides of the brain.Bone marrow cytology showed that infected bone marrow, blood culture and bone marrow culture all suggested MRSAA.In the course of anti-infection treatment, cardiac murmur appeared, hemoglobin and platelets decreased gradually, aortic valve neoplasm was found by color Doppler echocardiography, which was diagnosed as infective endocarditis.According to drug sensitivity test, vancomycin antiinfective therapy was used in 1 case and 1 case died after 6 weeks.It is suggested that children with fever of unknown causes should pay attention to dynamic observation of cardiac murmur and timely exclusion of IEs by color Doppler echocardiography. Children with encephalic symptoms have skin that is difficult to explain with thrombocytopenia.When the mucous membrane bleeds, should also guard against IE.
【作者单位】：遵义医学院附属医院小儿内科;
【分类号】：R725.4

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