[NEJM临床医学影像]:创伤弧菌感染 | 中国病理生理学会危重病医学专业委员会
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2018年08月08日 临床影像, 临床话题 暂无评论


Vibrio vulnificus Infection

Jin Park, and Chang-Seop Lee

N Engl J Med 2018; 379:375

DOI: 10.1056/NEJMicm1716464

A 71-year-old man presented to the emergency department with a 2-day history of fever and excruciating pain in his left hand that had developed 12 hours after eating raw seafood. He had a history of type 2 diabetes mellitus and hypertension and was undergoing hemodialysis for end-stage renal disease. At the time of presentation, hemorrhagic bullae measuring 3.5 by 4.5 cm had developed on the palm of his left hand (Panel A), and erythematous swelling with confluent tense bullae and ecchymoses had developed on the dorsum of the hand and forearm (Panel B). Surgical intervention was performed urgently, and Vibrio vulnificus was isolated from the bullae. Postoperatively, the patient received intravenous ceftazidime and ciprofloxacin. V. vulnificus can cause skin infections after wound exposure to contaminated seawater, as well as primary septicemia through the consumption of contaminated raw or undercooked seafood. Patients with immunocompromising conditions, including chronic liver disease and cancer, are at increased risk for infection and complications. Despite treatment, the skin lesions progressed to deep necrotic ulcers, and amputation of the left forearm was performed 25 days after presentation. The patient did well after the surgery and was discharged home.

一名71岁男性患者因食用生海鲜后12小时出现发热及左手极度疼痛持续2天到急诊就诊。患者既往有2型糖尿病及高血压病史,并因终末期肾病接受血液透析治疗。就诊时,患者左手手掌出血3.5 x 4.5 cm大小的出血性大泡(图A),手和前臂背侧出现红肿伴融合性张力性大泡及瘀斑(图B)。紧急采取了外科干预,从大泡中分离到创伤弧菌。术后,患者接受了静脉头孢他啶及环丙沙星治疗。伤口一旦接触被创伤弧菌污染的海水,能够引起皮肤感染;食用被污染的生海鲜或未熟海鲜,还可引起原发性菌血症。免疫功能抑制患者,包括慢性肝病及肿瘤患者,发生感染及并发症的风险更高。尽管接受了上述治疗,患者皮损仍持续进展,最终发展为深的坏死性溃疡,最终在就诊25天后进行了左前臂截肢。患者术后恢复良好,最终出院回家。



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