摘要
15岁女童,因出疹2天并发热(T38.4℃)静脉滴注地塞米松(量不详)。次日,皮疹加重并出现出血性疱疹,伴腰痛;第3天出现头痛、恶心、呕吐,查WBC19.65×109/L,RBC3.65×1012/L,Hb123g/L,PLT46×109/L,ALT4247U/L,AST4719U/L,LDH1209U/L,CK612U/L。入院后患者精神恍惚,全腹压痛,双肾区叩痛;HR130次/min,BP86/60mmHg;WBC17.4×109/L,L0.32;RBC2.56×1012/L,Hb93g/L,PLT27×109/L;尿潜血(+);PO211.76mmHg,PCO22.5mmHg;2周内有与水痘患者密切接触史,诊断为水痘,水痘脑炎,多器官功能损害,感染性休克,弥漫性血管内凝血,代谢性酸中毒。给予升压、扩容、止血、纠正酸中毒、抗感染等治疗,但患者出现呕血,口腔、鼻腔持续出血,无尿,血压下降,深度昏迷,入院12h死亡。
A 15-year-old girl received IV dexamethasone （ dosage not stated） for a fever（ T 38.4 ℃ ） 2 days after the occurrence of eruption. The next day, her skin rash aggravated and she developed hemorrhagic herpes accompanied by lumbago. The third day, she developed headache, nausea, and vomiting. Laboratory tests revealed the results as follows： WBC 19.65 ×10^9/L, RBC 3.65×10^12/ L, Hb 123 g/L, PLT 46 ×10^9/L, ALT 4 247 U/L, AST 4 719 U/L, LDH 1 209 U/L, and CK 612 U/L. After hospitalization, the patient presented with trance, tenderness over the abdomen, percussion pain in the both renal region. Her heart rate was 130 boats/ min and blood pressure was 86/60 mmHg. Laboratory tests showed the following values： WBC 17, 4 ×10^9/L, L 0.32, RBC 2. 56 ×10^12/L, Hb 93 g/L, PLT 27 ×10^9/L, urine occult blood（ ＋ ）, PO2 11.76 mmHg, and PCO： 2.5 mmHg. She had a history of contacting closely with the patient with varicella within 2 weeks. She was diagnosed as varicella, varicella encephalitis, multiorgan injury, infective shock, disseminated intravascular coagulation, and metabolic acidosis, The patient was given treatments with elevation of blood pressure, blood volume expansion, hemostasis, correction of acidosis, anti-infection. But she developed haematemesis, continuous bleeding from oral and nasal cavity, anuria, blood pressure reduction, and deep coma. She died 12 hours after hospitalization.
出处
《药物不良反应杂志》
2007年第5期339-340,共2页
Adverse Drug Reactions Journal
关键词
地塞米松
水痘
多器官衰竭
死亡
鉴别诊断
dexamethasone
varicella
multiorgan failure
death
differential diagnosis
