SARS继发曲菌感染死亡1例临床病理学观察

Clinicopathological features of a SARS patient died from secondary aspergillus infection

目的 探讨重症急性呼吸综合征 (SARS)的死因和病变特征。方法 常规HE染色 ,组织化学Macchiavello法、MSB、网状纤维、PAS染色法进行观察。结果 SARS增生修复期改变 ;继发性肺曲菌病伴双肺广泛化脓性炎 ,严重的肺组织破坏 ,肺水肿 ,肺出血 ,气管、支气管、小支气管血液吸入 ;霉菌性败血症伴全身器官播散性、多发性曲菌性脓肿、局部组织坏死及出血伴纤维素性坏死性血管炎、血栓及霉菌菌栓形成 ;免疫器官抑制 :脾红髓及白髓等淋巴组织严重减少 ,淋巴组织灶状坏死 ;纤维组织增生 ;淋巴结淋巴滤泡减少 ,生发中心消失 ,间质纤维化 ;骨髓粒细胞系、巨核细胞系减少 ,红细胞系灶状增生。结论 患者死于免疫功能抑制继发感染性多器官衰竭。提示对SARS的皮质激素治疗要适时视情慎用。

Objective To investigate the pathological changes and death cause of a patient with “severe SARS” diagnosed clinically. Methods Routine HE stain, histochemical Machiavelli's method, MSB stain, reticular fiber and PAS stains were used. Results Typical pathological changes of SARS during proliferative and repair stage were observed in the Lungs. Moreover, we found distinguished pathological features of severe intensive changes caused by secondary infection of aspergillosis in this case. Bilateral and extensive superlative pneumonia, severe destruction of lung tissue, pulmonary edema and hemorrhage, blood aspiration in trachea, bronchi and small bronchi were also observed. Meanwhile, aspergilla septemia with diffuse multiple organ abscess involved heart, brain, lung, liver, kidney, spleen, stomach, pancreas, adrenal gland, bronchopulmonary lymphnodes and aspergillic embolism. In addition, morphological changes of immune suppression were also found, including severe diminution of lymphoid tissues such as red pulp and white pulp of the spleen,localized necrosis in lymph tissue, fibroplation proliferation,diminution of the lymphoid follicle, disappear of the germinal center, fibrosis in lymph node, and diminution of granulocyte series and megakaryocyte series of the bone marrow with spot hyperplasia of the erythron. Conclusion This patient died from multiple organ failure secondary with aspergillus infection is related to corticosteroids therapy. It is suggests that application of corticosteroids therapy should be carefully considered in the patient.