Kaposi水痘样疹合并严重并发症1例报告

Kaposi varicelliform eruption with severe complications: a case report

目的探讨Kaposi水痘样疹合并严重并发症的临床特征与预后。方法回顾分析1例Kaposi水痘样疹合并严重并发症患儿的临床资料并复习相关文献。结果男孩,5个月。反复头面部皮疹3个月,突发加重3天住院。皮损特征为典型脐凹性水疱及出血性结痂,有严重低蛋白血症、低钙血症及电解质紊乱,低钙血症逐渐加重。入院第5天出现高热、抽搐及心动过速,血培养示耐甲氧西林金黄色葡萄球菌(MASA)感染,确诊为脓毒血症。当日出现凝血功能紊乱,先后予以夫西地酸、万古霉素抗感染,阿昔洛韦抗病毒,丙种球蛋白、白蛋白、冷沉淀、血浆、葡萄糖酸钙,补充白蛋白、凝血因子等治疗后,患儿病情逐渐稳定,住院19天出院。结论 Kaposi水痘样疹患儿合并低蛋白血症、低钙血症时提示病情重,需警惕脓毒症、凝血功能紊乱,甚至感染性休克和弥漫性血管内凝血。

ObjectiveTo investigate the clinical features and prognosis of Kaposi varicelliform eruption with severe complications. MethodsThe clinical data of one child with Kaposi varicelliform eruption with severe complications was retrospectively analyzed. The related literatures were reviewed. ResultsA 5-month-old boy presented with recurrent rash on the head and face for 3 months and aggravated for 3 days. The skin lesions showed a characteristic of typical dome-shaped blisters with hemorrhagic crusting. At admission, the boy suffered with severe hypoproteinemia, hypocalcemia, and electrolyte disorder. The hypocalcemia was aggravated gradually. On the ffth day of admission, the boy had fever, convulsions, and tachycardia. Blood culture showed methicillin-resistant Staphylococcus aureus （MASA） infection. The diagnosis of sepsis was confrmed. At that very day, the boy started to have coagulopathy, so Fusidic and Vancomycin for anti-infection, Acyclovir for antivirus, intravenous infusion immunoglobulin, albumin, cryoprecipitate, plasma and calcium gluconate were administered, supplied with albumin and blood coagulation factor. The boy’s condition gradually became stable and discharged on the 19th day after admission. ConclusionsWhen Kaposi varicelliform eruption is complicated with hypoproteinemia and hypocalcemia, the critical illness is indicated. Clinicians should be alerted to the existence of sepsis, coagulation disorders, even septic shock and disseminated intravascular coagulation.