合并重症肺炎、脑炎、多器官功能障碍的重症恙虫病1例

谢秀银; 王库良; 谢友玲; 韦晴霏

doi:10.16766/j.cnki.issn.1674-4152.003274

合并重症肺炎、脑炎、多器官功能障碍的重症恙虫病1例

doi: 10.16766/j.cnki.issn.1674-4152.003274

广西医科大学第四附属医院全科医学科，广西柳州 545000

详细信息

通讯作者:
韦晴霏, E-mail: wqf68@126.com

中图分类号: R513.2
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- 被引次数: 0
出版历程
- 收稿日期: 2022-11-13
- 网络出版日期: 2024-01-13

Severe tsutsugamushi disease complicated with severe pneumonia, ncephalitis and multiple organ dysfunction: a case report

Department of General Practice, Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi 545000, China

摘要

摘要: 恙虫病是一种由恙虫病东方体引起的急性自然疫源性传染病，为目前最易漏诊的传染病之一，以突然起病、高热、皮肤焦痂或溃疡、淋巴结肿大为特征，基础病理改变为血管炎及血管周围炎，临床表现为不同程度的器官功能损害、功能坏死甚至衰竭。本文报道以发热为首发症状，合并重症肺炎、脑炎、多器官功能障碍的重症恙虫病患者1例，经治疗后痊愈出院。本文就此病例进行报告及文献复习，旨在提高临床对恙虫病的认识，做到早诊断、早治疗，个体化治疗。
- 恙虫病 /
- 重症恙虫病 /
- 重症肺炎 /
- 脑炎 /
- 多器官功能障碍
Abstract: Scrub typhus is an acute natural infectious disease caused by infection with Orientia tsutsugamushi, one of the most easily overlooked infectious diseases today. It is characterized by sudden onset with high fever, skin eschar or ulcer and lymph node enlargement. The basic pathological changes are vasculitis and perivasculitis and the clinical manifestations are varying degrees of organ dysfunction, necrosis and even failure. This paper reports a case of severe tsutsugamushi disease with fever as the first symptom and severe pneumonic encephalitis and multiple organ dysfunction, which was cured and discharged after treatment. By reporting this case and reviewing the literature, this article aims to improve the clinical understanding of Tsutsugamushi disease in order to achieve early diagnosis, early treatment, and individualized treatment.
- Srcub typhus /
- Severe tsutsugamushi disease /
- Severe pneumonia /
- Encephalitis /
- Multiple organ dysfunction

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图 1 患者血生化复查结果

Figure 1. Blood biochemical reexamination results of the patient

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图 2 患者头颅MRI情况

注：A~D为7月10日头颅MRI，箭头示右侧额顶颞岛叶见片状、脑回状液体衰减反转恢复序列稍高、T₂WI稍高信号影，局部病灶表观弥散系数呈低信号、核磁弥散加权成像呈高信号，相应脑实质稍肿胀，脑沟稍变窄。E~F为7月22日头颅MRI，箭头示右侧额顶颞岛叶见片状、脑回状T₁WI稍低、T₂WI稍高信号影，较7月10日的范围缩小，相应脑实质肿胀减轻，脑沟稍变窄。

Figure 2. Head MRI of the patient

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图 3 患者胸部CT检查情况

注：A为7月10日胸部CT，箭头示两肺炎症，双侧胸腔积液，两肺下叶局部受压不张。B为7月22日胸部CT，箭头示两肺炎症较前明显好转，双胸腔积液大部分已吸收。C为9月2日胸部CT，肺炎痊愈，胸腔积液完全吸收。

Figure 3. CT examination of the patient's chest

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