学龄期儿童发热8天伴咯血

Pyrexia and hemoptysis for eight days in a school-age child

该文报道1例因发热8d伴咯血而诊断为丙球无反应型川崎病(KD)并肺出血的患儿。患儿女,学龄期儿童,以发热、皮疹、双侧颈部淋巴结肿大、结膜充血、唇红皲裂及杨梅舌为主要临床表现,随后出现双手、足肿胀,实验室检查示WBC、PLT及C反应蛋白明显增高,血沉明显增快,肝脏酶学升高,白蛋白降低及无菌性脓尿。第1疗程静脉注射丙种球蛋白(IVIG)治疗后仍反复发热,入院第2天出现咯血,肺CT示透亮度不均,有斑片状阴影。予第2疗程的IVIG、甲基强的松龙联合阿司匹林治疗后,病情迅速缓解。KD是儿童时期一种以多系统血管炎为主要特征的发热性疾病,可累及心脏、肾脏、肺及神经系统等多个系统,临床上需要仔细监测和认识KD的少见症状,早期认识到KD的肺部并发症可避免延误诊断和防止更严重并发症的发生,并有助于早期治疗及疾病的恢复。

A girl was diagnosed with intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) due to pyrexia and hemoptysis for eight days. The girl was a school-age child with major clinical manifestations of pyrexia, skin rash, enlargement of bilateral cervical lymph nodes, conjunctival hyperaemia, red and cracked lips and strawberrylike tongue, followed by swelling of both hands and feet. Laboratory examination showed significant increases in white blood cell count, platelet count, C-reactive protein, erythrocyte sedimentation rate and liver enzymes, a significant reduction in albumin, and the presence of aseptic pyuria. After the first course of IVIG treatment, the girl still had recurrent pyrexia, with hemoptysis on day 2 after admission, and lung CT showed uneven luminance and patchy shadow. The symptoms were quickly alleviated after the second course of IVIG treatment combined with methylprednisolone and aspirin treatment. KD is a febrile disease characterized by multiple systemic vasculitis in childhood and can involve various organ systems such as the heart, lungs, kidneys and the nervous system. Therefore, it is necessary to carefully monitor and recognize the rare symptoms of KD, and early recognition of pulmonary complications of KD can avoid delay in diagnosis, prevent the development of more serious complications, and help with early treatment and disease recovery.