血液恶性肿瘤患者并发葡萄球菌性烫伤样皮肤综合征四例并文献复习

Staphylococcal scalded skin syndrome in patients with hematologic malignancy： a report of 4 cases

目的探讨血液恶性肿瘤患者中葡萄球菌烫伤样皮肤综合征（SSSS）的发病、诊断及治疗情况。方法分析2006年11月至2008年6月本院诊治的4例SSSS患者的临床资料，并进行文献复习。结果4例患者均在免疫力严重低下时发病，2例在粒细胞缺乏期，2例在强效免疫抑制剂治疗严重移植物抗宿主病之后，均有高热和典型的皮肤病变；其中3例经万古霉素联合静脉丙种球蛋白治疗好转；造血干细胞移植后的患者减少免疫抑制剂的应用对SSSS治疗有益。结论葡萄球菌烫伤样皮肤综合征在血液恶性肿瘤患者中并非罕见，应该作为高热合并皮肤红斑、大疱及表皮松解患者的鉴别诊断之一。

Objective To investigate the development of Staphylococcal scalded skin syndrome （SSSS） in patients with hematologic malignancy. Methods The clinical data of 4 cases of SSSS admitted from November 2006 to June 2008 were analyzed, and the related literatures were reviewed. Results Four patients developed SSSS all under severe immunosuppression. Two of them were in neutropenia, and the others had been intensively treated for severe graft versus host disease. They presented high fever and erythema, followed by the formation of flaccid bullae and exfoliation. Three patients recovered successfully with the treatment of vancomycin and intravenous administration of immunoglobulin. Withdraw of nununosuppressive agents in patients following hematopoietic stem cell transplantation was helpful. Conclusions SSSS should be considered when high fever and erythema suddenly occur in patients with hematologic malignancy.