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肺炎链球菌感染合并爆发性紫癜一例报告
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Abstract:
本文报告了一例老年男性患者，因肺炎链球菌(Streptococcus pneumoniae)感染致脓毒血症并发爆发性紫癜(Purpura Fulminans, PF)而死亡的病例。患者因“气促伴全身酸痛1天余，加重3小时”由急诊入院，病程急剧恶化，迅速发展为感染性休克爆发性紫癜(Purpura Fulminans, PF)及多器官功能衰竭。尽管进行了积极的抗生素治疗、重症监护支持和替代治疗，患者仍在入院后48小时内死亡。本病例旨在提高对肺炎链球菌相关暴发性紫癜这一罕见但致命性并发症的认识，强调其起病急骤、病情凶险及早期识别及干预的重要性。
This paper reports a fatal case of an elderly male patient who died of sepsis complicated with purpura fulminans (PF) caused by Streptococcus pneumoniae infection. The patient was admitted to the Emergency Department due to “dyspnea with generalized myalgia for more than 1 day, aggravated for 3 hours”. The disease progressed rapidly, evolving into septic shock, purpura fulminans (PF), and multiple organ failure. Despite aggressive antibiotic therapy, intensive care support, and replacement therapy, the patient died within 48 hours of admission. This case aims to enhance the understanding of this rare but life-threatening complication of Streptococcus pneumoniae-related purpura fulminans, emphasizing its acute onset, critical condition, and the importance of early identification and intervention.
| [1] | Klifto, K.M., Gurno, C.F., Grzelak, M.J., Seal, S.M., Asif, M., Hultman, C.S., et al. (2019) Surgical Outcomes in Adults with Purpura Fulminans: A Systematic Review and Patient-Level Meta-Synthesis. Burns & Trauma, 7, Article No. 30. https://doi.org/10.1186/s41038-019-0168-x |
| [2] | Teo, H.G., Wong, J.Y. and Ting, T.L.L. (2017) Purpura Fulminans: A Rare Presentation of Streptococcus pneumoniae Infection. BMJ Case Reports, 2017, bcr-2017-221150. https://doi.org/10.1136/bcr-2017-221150 |
| [3] | Nasrullah, A., Javed, A., Tariq, U., Young, M., Moeen, Z. and Balaan, M. (2019) Purpura Fulminans: A Rare but Fierce Presentation of Pneumococcal Sepsis. European Journal of Case Reports in Internal Medicine, 7, Article ID: 001373. |
| [4] | Konda, S., Zell, D., Milikowski, C. and Alonso-Llamazares, J. (2013) Purpura Fulminans Associated with Streptococcus pneumoniae Septicemia in an Asplenic Pediatric Patient. Actas Dermo-Sifiliográficas (English Edition), 104, 623-627. https://doi.org/10.1016/j.adengl.2012.05.027 |
| [5] | Asakura, T., Higuchi, A. and Mori, N. (2016) Streptococcus pneumoniae-Induced Purpura Fulminans. QJM, 109, 499-500. https://doi.org/10.1093/qjmed/hcw060 |
| [6] | Sinwar, P.D. (2014) Overwhelming Post Splenectomy Infection Syndrome—Review Study. International Journal of Surgery, 12, 1314-1316. https://doi.org/10.1016/j.ijsu.2014.11.005 |
| [7] | Wojtowicz, J.M. and Jones, G.L. (2014) Streptococcus pneumoniae-Induced Purpura Fulminans in a Woman with Functional Asplenia. Canadian Journal of Emergency Medicine, 16, 339-342. https://doi.org/10.2310/8000.2013.130990 |
| [8] | Lerolle, N., Carlotti, A., Melican, K., Aubey, F., Pierrot, M., Diehl, J., et al. (2013) Assessment of the Interplay between Blood and Skin Vascular Abnormalities in Adult Purpura Fulminans. American Journal of Respiratory and Critical Care Medicine, 188, 684-692. https://doi.org/10.1164/rccm.201302-0228oc |
| [9] | Alvarez, E.F., Olarte, K.E. and Ramesh, M.S. (2012) Purpura Fulminans Secondary to Streptococcus pneumoniae Meningitis. Case Reports in Infectious Diseases, 2012, Article ID: 508503. https://doi.org/10.1155/2012/508503 |
| [10] | 罗海燕, 祝益民. 暴发性紫癜的治疗进展[J]. 中国小儿急救医学, 2006(1): 74-75. |
| [11] | Watanabe, Y. and Abe, T. (2017) Purpura Fulminans Due to Pneumococcal Infection. Journal of General and Family Medicine, 18, 458-459. https://doi.org/10.1002/jgf2.105 |
| [12] | Gerson, W.T., Dickerman, J.D., Bovill, E.G. and Golden, E. (1993) Severe Acquired Protein C Deficiency in Purpura Fulminans Associated with Disseminated Intravascular Coagulation: Treatment with Protein C Concentrate. Pediatrics, 91, 418-422. https://doi.org/10.1542/peds.91.2.418 |
| [13] | Salinas, U., Unzueta, J., Vidarte, M.A., et al. (2007) Meningococcal Purpura Fulminans: Treatment with Recombinant Protein C Activator in 3 Cases. Revista Espanola de Anestesiologia y Reanimacion, 54, 503-506. |
| [14] | Hodgson, A., Ryan, T., Moriarty, J., Mellotte, G., Murphy, C. and Smith, O.P. (2002) Plasma Exchange as a Source of Protein C for Acute Onset Protein C Pathway Failure. British Journal of Haematology, 116, 905-908. https://doi.org/10.1046/j.0007-1048.2002.03353.x |
| [15] | Lammers, J. (2012) The Value of Prophylactic Vaccinations and Antibiotic Treatment in Post-Splenectomy Patients: A Review. Transplant Research and Risk Management, 4, 19-24. https://doi.org/10.2147/trrm.s25198 |
| [16] | Luu, S., Spelman, D. and Woolley, I.J. (2019) Post-Splenectomy Sepsis: Preventative Strategies, Challenges, and Solutions. Infection and Drug Resistance, 12, 2839-2851. https://doi.org/10.2147/idr.s179902 |
