论文部分内容阅读
1例15岁女性患者,因皮肌炎口服泼尼松治疗2年(初始剂量60 mg/d;维持量15 mg/d,隔日1次),出现发热、头痛、呕吐、双下肢无力。经头孢哌酮钠舒巴坦钠、利巴韦林、维生素C及维生素B6治疗无好转,症状进行性加重,出现行走困难。体格检查:体温38.0℃,颈强直;双下肢布满褐色斑疹,部分中央可见脓点;四肢肌力Ⅲ级,肌张力减弱,腱反射减低;Kernig征及Brudzinski征阳性。脑脊液常规检查见大量真菌,白细胞数1×106/L,蛋白890 mg/L,葡萄糖1.4 mmol/L,氯化物99.7 mmol/L,墨汁染色检出新型隐球菌。诊断为新型隐球菌性脑膜炎,虽予积极救治,终因呼吸循环衰竭死亡。
A 15-year-old woman developed fever, headache, vomiting and weakness in his lower extremities with dermatomyositis treated with prednisone for 2 years (initial dose 60 mg / d; maintenance dose 15 mg / d every other day). Cefoperazone sodium and sulbactam sodium, ribavirin, vitamin C and vitamin B6 treatment did not improve, the symptoms progressively worsened, walking difficulties. Physical examination: body temperature 38.0 ℃, neck stiffness; both lower extremities covered with brown spots, some of the central pus can be seen; limb muscle strength Ⅲ grade, weakened muscle tone, tendon reflexes reduced; Kernig sign and Brudzinski sign positive. Cerebrospinal fluid routine examination revealed a large number of fungi, leukocyte count 1 × 106 / L, protein 890 mg / L, glucose 1.4 mmol / L, chloride 99.7 mmol / L, ink stain detection of Cryptococcus neoformans. Diagnosis of cryptococcal meningitis, although positive treatment, eventually died of respiratory failure.