2型糖尿病合并银屑病患者再次感染麻疹1例报告并文献分析

Patients with type 2 diabetes mellitus and psoriasis re-infected with measles:one case report and literature analysis

目的分析糖尿病合并银屑病患者发生麻疹再次感染的皮疹特点及诊疗过程,减少该类患者在临床中诊治的延误。方法对榆林市第一医院2015年4月诊治的糖尿病合并银屑病患者发生麻疹再次感染1例的临床资料结合文献进行分析。结果患者因多饮多尿3年、发热3 d入院。入院后予以降糖、抗炎治疗效果不佳。3 d后见四肢躯干皮疹。患者既往有麻疹感染病史。结合临床,不排除麻疹病毒感染,故外送查病原体,证实为麻疹病毒感染。考虑系麻疹病毒变异导致的再次感染。由于患者合并银屑病且长期使用阿维A胶囊和卡泊三醇,导致不典型的皮疹。予降糖、抗病毒同时调整抗生素治疗后,体温正常,皮疹逐渐消退。结论对于2型糖尿病合并银屑病患者,如有发热应综合考虑,警惕麻疹病毒变异导致的再次感染,应及时进行病原学诊断,以免漏诊和延误治疗。

Objective To analyze the rash characteristics and diagnosis and treatment process of measles infection in patients with diabetes mellitus and psoriasis,to reduce the clinical diagnosis and treatment delay of such patients.Methods The clinical data of a patient with diabetes combined with psoriasis and measles infection who was diagnosed and treated in The First Hospital of Yulin in April 2015 were analyzed.Results The patient was admitted to hospital due to polydipsia and polyuria for 3 years and fever for 3 days.Hypoglycemic and anti-inflammatory treatment after admission was not good.On the third day after hospitalization,rash on the trunk and the extremities was seen.The patient had a history of measles infection.Based on clinical practice,Measles morbillivirus infection was not excluded,and Measles morbillivirus infection was confirmed by pathogen inspection.Measles reinfection was considered to be caused by variation of Measles morbillivirus.The atypical rash formed because of the patient's need for long-term treatment with Acitretin capsule and capotriol for psoriasis.After adjusting the antibiotic treatment,hypoglycemia and antiviral therapy were given,the body temperature was normal and the rash gradually subsided.Conclusion For patients with type 2 diabetes mellitus and psoriasis,if they have a fever,they should be considered comprehensively to guard against re-infection caused by measles virus mutation.Timely etiological diagnosis is performed to avoid missed diagnosis and delayed treatment.