坏死性肉芽肿性血管炎一例误诊分析并文献复习

坏死性筋膜炎伴感染性休克1例并文献复习
史梦军;管忠安
【期刊名称】《中国民间疗法》
【年(卷),期】2024(32)10
【摘要】坏死性筋膜炎(NF)是一种罕见的由多种细菌侵入软组织造成的严重软组织感染性疾病,主要累及深筋膜、浅筋膜,以起病急、进展迅速、病死率高为特点。

NF,皮损处疼痛感明显,可伴有严重的全身毒性反应,如感染性休克和多器官衰竭。

对于NF应尽早明确诊断,及时进行手术干预,清除坏死组织,控制感染。

中西医结合方法能改善临床症状,提高NF患者的生存率。

该文介绍采用中西医结合方法治疗坏死性筋膜炎伴感染性休克病案1则,并对NF进行文献复习。

【总页数】4页(P103-106)
【作者】史梦军;管忠安
【作者单位】山东中医药大学
【正文语种】中文
【中图分类】R261
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软组织结核性肉芽肿误诊报告并文献复习王雪彬;林桂英;冯修高;徐向进【摘要】目的：探讨软组织结核性肉芽肿的临床特征,减少误诊误治。

方法对我院收治的1例软组织结核性肉芽肿的临床资料进行回顾性分析,并复习国内外文献。

结果本例因右上肢多关节肿痛伴多发皮下肿物反复发作2年余就诊。

查血红细胞沉降率31.0 mm/h,尿酸488.9μmol/L,结核杆菌γ-干扰素释放试验39.6 pg/ml。

体表肿物彩色多普勒超声示：右侧手背及腕关节皮下多发囊性及混合性回声区。

右腕关节MRI平扫+增强扫描示：右腕关节及掌指骨软组织信号异常。

遂行肿物切除,术后病理报告符合结核分枝杆菌感染性病变,确诊为软组织结核性肉芽肿,予抗结核治疗后好转出院。

出院后继续抗结核治疗,后因血肌酐明显升高,停用抗结核药。

随访5个月,关节肿痛及皮下肿物未复发。

结论软组织结核性肉芽肿临床少见,及时行结核杆菌γ-干扰素释放试验和局部组织病理检查,可有效减少误诊误治。

%Objective To investigate clinical features of soft tissues of tuberculous granulomas in order to reduce mis-diagnosis and mistreatment. Methods Clinical data of 1 misdiagnosed patient with soft tissues of tuberculous granulomas was retrospectively analyzed, and domestic and abroad literature was reviewed. Results The patient visited a doctor for arthralgia of right upper extremities accompanied by multiple subcutaneous tumors for more than 2 years. Medical examinations showed that erythrocyte sedimentation rate was 31. 0 mm/h, uric acid was 488. 9 μmol/L, and mycobacterium tuberculosisγ-interfer-on was 39. 6 pg/ml. Color doppler ultrasonography for body surface tumors showed that multiple cysts and mixed echoic area were found in right dorsum of handand wrist. Plain scan combined with enhanced MRI showed that anomaly signal of right wrist and soft tissues of metacarpus. Tumors were excised and performed pathological examination, and the postoperative result was fitted mycobacterium tuberculosis infection, and then tuberculous granulomas was confirmed. The patient was discharged after conditions had improved by antituberculous treatment. Antituberculous treatment was continued after discharged, but the treatment was stopped because of significantly increased serum creatinine level, and the patient had no recurrence of arthrocele or subcutaneous tumors during 5 months of follow-up. Conclusion Soft tissues of tuberculous granulomas is rare in clinical practice. Mycobacterium tuberculosis interferon-γ release test and histologic examination for local tissue should be performed timely to effectively reduce misdiagnosis and mistreatment.【期刊名称】《临床误诊误治》【年(卷),期】2016(029)012【总页数】3页(P30-32)【关键词】结核,皮肤;肉芽肿;皮下组织;关节炎,类风湿;误诊【作者】王雪彬;林桂英;冯修高;徐向进【作者单位】350025 福州，福建医科大学福总临床医学院风湿内分泌科;350025 福州，福建医科大学福总临床医学院风湿内分泌科;350025 福州，福建医科大学福总临床医学院风湿内分泌科;350025 福州，福建医科大学福总临床医学院风湿内分泌科【正文语种】中文【中图分类】R529.4结核病是结核分枝杆菌感染引起的慢性肉芽肿性疾病，是世界范围内除了人类获得性免疫缺陷综合征之外病死率最高的感染性疾病[1]，典型病变为结核性肉芽肿形成。

Tianjin Med J,July2017,Vol.45No.7长期误诊为肺感染的血管炎合并顽固心衰一例报告傅蕾1，王清泉2△摘要：韦格纳肉芽肿（WG）是一种以毛细血管、微小动静脉受累为主的全身坏死性肉芽肿性血管炎，典型的WG三联征为上下呼吸道、肾脏病变，只有呼吸道改变而无肾脏改变为局限性WG。

局限性WG因症状及影像学表现不特异，尤易误诊。

笔者发现1例仅表现肺部症状及顽固心衰的局限性WG，胸部CT表现为两肺多发不规则片状模糊密度增高影，被长期误诊为肺感染。

经查两次蛋白酶-3（PR-3）-抗中性粒细胞胞浆抗体（ANCA）阳性，最终诊断为ANCA相关性血管炎、WG。

本文回顾了该患者的诊治经过并复习相关文献资料。

关键词：血管炎；韦格纳肉芽肿病；肺炎；误诊；顽固心衰中图分类号：R593.2文献标志码：D DOI：10.11958/20170501A case report of the vasculitis misdiagnosed as pneumonia with stubborn heart failureFU Lei1,WANG Qing-quan2△1Tianjin University of Traditional Chinese Medicine,Tianjin300193,China;2the First Affiliated Hospital ofTianjin University of Traditional Chinese Medicine△Corresponding Author E-mail:641529563@Abstract:Wegener’s granulomatosis(WG)is a kind of systemic necrotizing granulomatous vasculitis characterized by capillary and small arteriovenous involvement.The typical WG triad is lesions of the upper and lower respiratory tract and kidneys.Only changes in the respiratory tract without renal lesions are localized WG.Localized WG is very easy to be作者单位：1天津中医药大学（邮编300193）；2天津中医药大学第一附属医院作者简介：傅蕾（1992），女，硕士在读，主要从事中医治疗危重病及疑难病研究△通讯作者E-mail：641529563@症入院时应排查GS，对GS合并骨关节炎患者，尽快纠正低镁血症及代谢性碱中毒，可能对软骨钙化的防治有积极作用。

婴儿慢性肉芽肿病三例临床误诊分析周俊;张海燕【摘要】Objective To investigate the clinical features of infants with chronic granulomatous disease (CGD) in order to avoid misdiagnosis and mistreatment.Methods The data of 3 CGD infants admitted to Xiaogan Central Hospital were analyzed retrospectively and related literature was reviewed.Results There were 3 male infants,with an average age of 2.3 months at onset and of 4.6 months at diagnosis.All 3 cases had repeated cough,wheeze and fever,including 1 with the left axillary lymph node enlargement,1 with diarrhea,and 1 with repeated skin abscess.The disease was misdiagnosed as severe pneumonia,skin soft tissue infection and BCG,and the symptoms were not improved after conventional treatment.After admission,the patients underwent the medical examinations and gene analysis,and were diagnosed as havingCGD.Unfortunately,one case died,one case gave up treatment and was lost to follow-up,and one was discharged in a stable condition.Conclusion Early CGD in infants is characterized by pulmonary infection,leading to difficult diagnosis in clinical practice.Neutrophil respiratory burst detected by flow cytometry-DHR assay contributes to primary screening,and further improvement of gene testing can be used to confirm the diagnosis.%目的探讨婴儿慢性肉芽肿病(chronic granulomatous disease,CGD)的临床特点,减少误诊误治.方法对我院收治并确诊为婴儿CGD3例的临床资料进行回顾性分析,并复习相关文献.结果本组3例均为男性,发病年龄平均2.3个月,确诊年龄平均4.6个月,2例有家族史.3例均因反复咳嗽、喘息伴发热就诊,伴左侧腋下淋巴结增大、腹泻、皮肤脓肿各1例.病初误诊为重症肺炎、皮肤软组织感染、卡介菌病等,予对症治疗后症状未见好转.入院后行相关医技检查及基因测序,确诊为CGD,其中1例死亡,1例放弃治疗,1例治疗后病情稳定带药出院.结论婴儿CGD早期诊断较困难,及时行基因测序及中性粒细胞呼吸暴发试验有助于明确诊断,避免误诊误治.【期刊名称】《临床误诊误治》【年(卷),期】2018(031)003【总页数】3页(P9-11)【关键词】肉芽肿病,慢性;婴儿;误诊;肺炎;软组织感染【作者】周俊;张海燕【作者单位】432000 湖北孝感,孝感市中心医院儿科1病区;432000 湖北孝感,孝感市中心医院儿科1病区【正文语种】中文【中图分类】R730.263慢性肉芽肿病(chronic granulomatous disease, CGD)为原发性免疫缺陷病，发病率为1/25万[1]，是基因突变引起还原型辅酶Ⅱ氧化酶复合物缺陷，导致吞噬细胞不能有效杀伤过氧化物酶阳性细菌与真菌，临床表现为反复细菌及真菌感染、局部肉芽组织形成，婴儿期病死率高。