文献简介

出版社:JAMA Dermatology

作  者:Jennifer Scott, BS; Christina Clarke, MD; Richard Marchell, MD

编  号:

关键字:Rat bite fever

年  份:2017   点击量:250

文献摘要 全文翻译

A man in his 70s was admitted to the hospital with encephalopathy, recent falls, leukocytosis, nausea, and arthralgias. On presentation to the emergency department, he received antibiotics owing to a concern for aspiration pneumonia. He underwent a stroke workup, including transesophageal echocardiography (TEE), results of which were negative. He was noted to have a progressing cutaneous eruption during his admission, and the dermatology department was consulted. He was found to have scattered petechiae and hemorrhagic vesicles, with most concentrated on the hands and feet (Figure, A and B). Palpable purpura were noted across the extremities. Several lesions were studded with pustules. He had an enlarging bulla on his left wrist. An abrasion on his left elbow was attributed to his recent falls. The infectious disease department was also consulted, and the patient was given broad-spectrum antibiotics owing to concern about endocarditis. As part of his dermatological workup, two 4-mm punch biopsy specimens were obtained (Figure, C and D). One was sent for histopathological examination, and the other was sent for fungal, bacterial, and mycobacterial cultures. A bacterial culture swab was obtained from the tense bulla on his left wrist.

患者男性,70余岁,因脑病、近期跌倒、白细胞增多、恶心和关节痛而入院。患者在急诊科自述因担心吸入性肺炎而接受抗生素治疗。患者接受中风检查,包括经食管超声心动图检查(TEE),结果呈阴性。患者入院时被指患有进行性皮疹,并咨询了皮肤科医生。且发现患者出现分散瘀点和出血性水疱,大部分集中于手部和脚部(图A和B)。肢端可触及紫癜。几处皮损处布满脓疱。患者左手腕有一肿胀大疱。患者因近期摔倒致左肘部擦伤。同时患者也咨询了传染病科,因担心心内膜炎,接受了广谱抗生素治疗。作为皮肤检查的一部分,获得了两个4 mm钻孔活检标本(图C和D)。其中一个标本用于组织病理学检查,另一标本用于真菌、细菌和分支杆菌培养。从患者左手腕紧张大疱处取细菌培养拭子。