儿童多发性大动脉炎误诊病例辨析

Misdiagnosis Analysis of Takayasu Arteritis in Children

目的分析儿童多发性大动脉炎(takayasu arteritis,TA)的临床特点,提高诊治水平。方法对以反复发热伴咯血为主要表现的儿童TA 1例的临床资料进行回顾性分析。结果本例因反复发热2个月,咯血1个月以发热、咯血原因待查收入院。曾误诊为急性上呼吸道感染、脓毒症、肺部感染,予对症治疗后病情未见好转。入院后完善肺动脉及胸腹主动脉血管成像及相关医技检查,确诊为TA,予甲泼尼龙大剂量冲击治疗,同时予降压、免疫抑制等措施,病情好转出院。随访半年,患者病情平稳,未复发。结论儿童TA临床表现缺乏特异性,完善相关医技检查是减少误诊误治的关键。

Objective To analyze the clinical characteristics of Takayasu arteritis（ TA）,in order to improve the diagnosis and treatment of TA. Methods A retrospective study of one child with TA whose symptoms were repeated fever and hemoptysis was performed. Results This patient was admitted to hospital because of repeated fever for two months and hemoptysis for one month,with unknown origin. The patient was once misdiagnosed as acute upper respiratory infection,sepsis and pneumonia,but the disease was not improved after symptomatic treatment. The patient was diagnosed with TA based on angiography of pulmonary artery and thoracic aorta as well as relevant tests in our hospital. The disease was improved and the patient was discharged after Methylprednisolone pulse therapy,antihypertensive drugs and immunosuppressive drugs for treatment. His condition was stable with no recurrence at 6-month follow-up. Conclusion Given non-specific clinical manifestations of TA in children,improving relevant tests is the key to reducing misdiagnosis and mistreatment.