免疫正常者非心源性多器官脓肿2例并文献复习

Two cases of non-cardiac multiple organ abscesses in normal immunocompetent patients and literature review

目的 分析2例免疫正常者非心源性多器官脓肿病例的临床特点,并进行文献复习,以提高对此类疾病的认识及鉴别诊断水平。方法 回顾性分析广东省人民医院2例免疫正常患者,非心源性多器官脓肿病例的临床资料及诊治过程。以 “多器官脓肿”为关键词,检索中英文数据库,筛选免疫正常患者病例进行总结。结果 66岁女性患者,间断发热8个月,左肩、肺部、腰4腰5椎体多发脓肿,多处淋巴结肿大,脓肿液培养找到马尔尼菲青霉菌,抗真菌治疗、脓肿切开引流后好转。35岁男性,咽痛、发热伴呼吸困难7d,迁徙性咽颈部、纵膈脓肿及脓胸,脓肿液培养找到麻疹孪生球菌及星座链球菌,经抗感染、脓肿切开引流、脓胸纤维板剥离术等治疗后痊愈。感染、肿瘤性疾病、自身免疫性疾病、部分遗传病、药物因素均可在原免疫力正常患者中引起全身多器官脓肿样病变,其中以感染性疾病为常见。结论 除感染性因素外,肿瘤、自身免疫性疾病等均可引起原免疫正常者非心源性多器官脓肿样病变,抗感染治疗无效时需注意排查相关疾病。脓肿液查找病原体、病理检查在鉴别诊断中起重要作用。

Objective To analyze 2 cases of noncardiac multi-organ abscesses in normal immunocompentent patients and reviewed the literature, to improve diagnostic capacity of such diseases. Methods 2 cases of non-cardiac multi organ abscesses in normal immunocompentent patients were analyzed. We searched the Chinese and English database for the keyword of non-cardiac multiple organ abscesses, and reviewed the reports on normal immunocompetent patients. Results A 66-year old female, complained of intermittent fever for 8 months. She had multiple abscesses in the left shoulder, lungs, L4 and L5 vertebra, and enlarged lymph nodes. Penicilliosis marneffei was found in the pyogenic fluids. With anti fungal treatment and drainage of the abscess in left shoulder, she got relieved. A 35 year-old male, complained of pbaryngalgia, fever and dyspnea for 7 days. He got migration abscesses in the pharynx, neck, mediastinum, and left plural cavity. Streptococcus eonstellatus and Gemella morbillorum were found in the pyogenic fluid. With antibiotic treatment, drainage of the abscess in the neck and decortications of lung, he recovered. Pathogen infection, tumor, autoimmune diseases, genetic diseases and medicine could present as multiple organ abscesses like lesions, with pathogen infection as the major cause. Conclusions Accept from pathogen infection, tumor and autoimmune diseases could present as multiple organ abscesses-like lesions in previously normal immunocompetent patients. When patients get no improvement with antibiotics, advanced investigation should be done to exclude tumor, autoimmune diseases, and so on.Investigations of pathogen and pathological examination play an important role in differential diagnosis.