儿童隐源性肝脓肿导致脓毒症合并非显性弥散性血管内凝血一例报道并文献复习

Non-overt DIC in Cryptogenic Liver Abscess-associated Sepsis in Children:a Case Report and Literature Review

儿童肝脓肿发病率低,查阅文献鲜有相关流行病学数据。肝脓肿可由胆管疾病、脓皮病、阑尾炎及创伤等导致,而隐源性肝脓肿病因不明,可仅表现为持续发热,无明显腹部不适,对早期诊断带来一定困难,延迟诊断可能发生脓毒症休克及弥散性血管内凝血(DIC),导致预后不良。本文报道1例耐甲氧西林金黄色葡萄球菌(MRSA)感染引起的隐源性肝脓肿导致脓毒症合并非显性DIC诊治过程。儿童隐源性肝脓肿是一种罕见的导致脓毒症的病因,不能确定感染灶时,除考虑血源性感染外,即使没有腹痛,也要将肝脓肿纳入鉴别诊断。

Liver abscess is rare in children,which is caused by biliary tract disease,pyoderma,appendicitis or trauma.There is little available relevant epidemiological data.In particular,cryptogenic liver abscess is difficult to diagnose at the early stage due to unknown etiology,and few clinical manifestations such as persistent fever without obvious abdominal discomfort.A delayed diagnosis may be associated with septic shock and DIC,leading to poor prognosis.We reported the diagnosis and treatment of a child with non-overt DIC in sepsis associated with cryptogenic liver abscess induced by infection with methicillin-resistant Staphylococcus aureus.The case report and literature review indicate that cryptogenic liver abscess is a rare cause of sepsis in children,which should be considered as a potential causative factor of sepsis besides hematogenous infection when the site of infection could not be determined regardless of whether abdominal pain is present or not.