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NEJM：坏疽性深脓疱病-病例报道

2017-12-07 xing.T MedSci原创

坏疽性深脓疱病免疫低下铜绿假单胞菌
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坏疽性深脓疱病是由铜绿假单胞菌菌血症相关的皮肤感染所致。感染通常发生在免疫功能低下或危重病患者身上，需要及时诊断和治疗。

患者为一名21岁接受诱导化疗的急性髓系白血病女性患者，在开始治疗后5天出现左膝关节病变而就诊。

体格检查发现一个2厘米的红斑边界出血性斑块（如图A所示）。患者无发热，除病变外，体检未发现异常。实验室检查结果值得注意的是全血细胞减少症，包括绝对嗜中性粒细胞计数为每立方毫米490个细胞（正常范围为950至5450）。病灶迅速进展为紫脓疱（如图B所示），患者随后出现发热（体温39.5℃）。对病变进行穿刺活检，标本呈血管周围性出血，中性粒细胞浸润，中心坏死。血液和伤口培养出铜绿假单胞菌，诊断为坏疽性深脓疱病。



坏疽性深脓疱病是由铜绿假单胞菌菌血症相关的皮肤感染所致。感染通常发生在免疫功能低下或危重病患者身上，需要及时诊断和治疗。患者静脉给予头孢他啶和庆大霉素治疗。由于怀疑深部感染，该患者接受了手术清创术（如图C所示）。随着患者从再生障碍期恢复，伤口基本愈合（图D展示了诱导化疗开始后约3个月的图片）。

该患者的急性髓系白血病没有完全缓解，随后进行异基因干细胞移植。
 
原始出处：
 
Anna K.M. Korte,et al. Ecthyma Gangrenosum.N Engl J Med.2017. http://www.nejm.org/doi/full/10.1056/NEJMicm1702302

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2038071, encodeId=4b2d20380e19a, content=<a href='/topic/show?id=716985205fb' target=_blank style='color:#2F92EE;'>#脓疱病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85205, encryptionId=716985205fb, topicName=脓疱病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sun Mar 11 00:21:00 CST 2018, time=2018-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=269046, encodeId=961c2690461c, content=很好，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Dec 13 07:29:23 CST 2017, time=2017-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268421, encodeId=6f522684210e, content=很好的病例.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/15/d6715bafce42cef990ac18b905ffc96c.JPG, createdBy=e1a3104890, createdName=Doctorbin, createdTime=Sun Dec 10 21:05:51 CST 2017, time=2017-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268145, encodeId=850d268145c2, content=见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Sat Dec 09 17:15:18 CST 2017, time=2017-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267692, encodeId=a10f26e69267, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Dec 08 06:38:16 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267560, encodeId=e44126e560b6, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Dec 07 13:43:06 CST 2017, time=2017-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267508, encodeId=830e26e5087f, content=好文章大家共同分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Dec 07 08:40:59 CST 2017, time=2017-12-07, status=1, ipAttribution=)]
    2018-03-11 12498c32m68暂无昵称

    #脓疱病#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2038071, encodeId=4b2d20380e19a, content=<a href='/topic/show?id=716985205fb' target=_blank style='color:#2F92EE;'>#脓疱病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85205, encryptionId=716985205fb, topicName=脓疱病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sun Mar 11 00:21:00 CST 2018, time=2018-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=269046, encodeId=961c2690461c, content=很好，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Dec 13 07:29:23 CST 2017, time=2017-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268421, encodeId=6f522684210e, content=很好的病例.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/15/d6715bafce42cef990ac18b905ffc96c.JPG, createdBy=e1a3104890, createdName=Doctorbin, createdTime=Sun Dec 10 21:05:51 CST 2017, time=2017-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268145, encodeId=850d268145c2, content=见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Sat Dec 09 17:15:18 CST 2017, time=2017-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267692, encodeId=a10f26e69267, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Dec 08 06:38:16 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267560, encodeId=e44126e560b6, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Dec 07 13:43:06 CST 2017, time=2017-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267508, encodeId=830e26e5087f, content=好文章大家共同分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Dec 07 08:40:59 CST 2017, time=2017-12-07, status=1, ipAttribution=)]
    2017-12-13 stupidox

    很好，学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2038071, encodeId=4b2d20380e19a, content=<a href='/topic/show?id=716985205fb' target=_blank style='color:#2F92EE;'>#脓疱病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85205, encryptionId=716985205fb, topicName=脓疱病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sun Mar 11 00:21:00 CST 2018, time=2018-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=269046, encodeId=961c2690461c, content=很好，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Dec 13 07:29:23 CST 2017, time=2017-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268421, encodeId=6f522684210e, content=很好的病例.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/15/d6715bafce42cef990ac18b905ffc96c.JPG, createdBy=e1a3104890, createdName=Doctorbin, createdTime=Sun Dec 10 21:05:51 CST 2017, time=2017-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268145, encodeId=850d268145c2, content=见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Sat Dec 09 17:15:18 CST 2017, time=2017-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267692, encodeId=a10f26e69267, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Dec 08 06:38:16 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267560, encodeId=e44126e560b6, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Dec 07 13:43:06 CST 2017, time=2017-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267508, encodeId=830e26e5087f, content=好文章大家共同分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Dec 07 08:40:59 CST 2017, time=2017-12-07, status=1, ipAttribution=)]
    2017-12-10 Doctorbin

    很好的病例.学习了

    0

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    2017-12-09 祝您健康

    见识了

    0

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    2017-12-08 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2038071, encodeId=4b2d20380e19a, content=<a href='/topic/show?id=716985205fb' target=_blank style='color:#2F92EE;'>#脓疱病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85205, encryptionId=716985205fb, topicName=脓疱病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sun Mar 11 00:21:00 CST 2018, time=2018-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=269046, encodeId=961c2690461c, content=很好，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Dec 13 07:29:23 CST 2017, time=2017-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268421, encodeId=6f522684210e, content=很好的病例.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/15/d6715bafce42cef990ac18b905ffc96c.JPG, createdBy=e1a3104890, createdName=Doctorbin, createdTime=Sun Dec 10 21:05:51 CST 2017, time=2017-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268145, encodeId=850d268145c2, content=见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Sat Dec 09 17:15:18 CST 2017, time=2017-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267692, encodeId=a10f26e69267, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Dec 08 06:38:16 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267560, encodeId=e44126e560b6, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Dec 07 13:43:06 CST 2017, time=2017-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267508, encodeId=830e26e5087f, content=好文章大家共同分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Dec 07 08:40:59 CST 2017, time=2017-12-07, status=1, ipAttribution=)]
    2017-12-07 Y—xianghai

    学习了新知识

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2038071, encodeId=4b2d20380e19a, content=<a href='/topic/show?id=716985205fb' target=_blank style='color:#2F92EE;'>#脓疱病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85205, encryptionId=716985205fb, topicName=脓疱病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sun Mar 11 00:21:00 CST 2018, time=2018-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=269046, encodeId=961c2690461c, content=很好，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Dec 13 07:29:23 CST 2017, time=2017-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268421, encodeId=6f522684210e, content=很好的病例.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/15/d6715bafce42cef990ac18b905ffc96c.JPG, createdBy=e1a3104890, createdName=Doctorbin, createdTime=Sun Dec 10 21:05:51 CST 2017, time=2017-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=268145, encodeId=850d268145c2, content=见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Sat Dec 09 17:15:18 CST 2017, time=2017-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267692, encodeId=a10f26e69267, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Dec 08 06:38:16 CST 2017, time=2017-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267560, encodeId=e44126e560b6, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Dec 07 13:43:06 CST 2017, time=2017-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=267508, encodeId=830e26e5087f, content=好文章大家共同分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Dec 07 08:40:59 CST 2017, time=2017-12-07, status=1, ipAttribution=)]
    2017-12-07 1e10c84am36(暂无匿称)

    好文章大家共同分享

    0