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暴发性紫癜是一种罕见的威胁生命疾病,链球菌感染恢复期的儿童最易受累,1960年报告一组患者的病死率>50%。本文报告1例对肝素治疗反应迅速,暂时停药时病情复发的病例。病例6.5岁男孩,入院前3周曾有发热、头痛、呕吐。入院前4天双大腿和颈部疼痛,继之颈部肿胀,拟诊淋巴结炎用青霉素V 治疗。入院前1天双下肢出现急进性红斑和大的紫癜,无血液病史及家族史。体检见双侧扁桃体Ⅲ°大,左侧有一小出血点,无渗出,四肢均可见2～4～6cm 大小不等的紫癜。入院时WBC 11200/分μ1、多形核细胞61%,杆状32%;血沉正常,血小板6.4万/μ1,凝血酶原时间(PT)>80秒,部分凝血激酶时间(PTT)>80秒,纤维蛋白原降解物(FDP)>40mg/d1,纤维蛋白原
Purpura is a rare, life-threatening disease that affects children most affected by convalescent streptococcal infections, and in 1960 a group of patients reported> 50% mortality. This article reports a case of rapid response to heparin therapy, the case of recurrent disease when temporarily discontinued. Case A 6.5-year-old boy had fever, headache and vomiting 3 weeks before admission. 4 days before admission, double thigh and neck pain, followed by neck swelling, proposed treatment of lymphadenitis with penicillin V treatment. One day before admission, there were acute erythema and purpura in both lower extremities with no history of blood diseases and family history. Physical examination showed bilateral tonsils Ⅲ ° large, there is a small bleeding on the left, no exudation, limbs are visible 2 ~ 4 ~ 6cm size purpura. Admission WBC 11200 / min μ1, polymorphonuclear cells 61%, rod 32%; normal erythrocyte sedimentation rate, platelets 64000 / μ1, prothrombin time (PT)> 80 seconds, partial thromboplastin time (PTT)> 80 seconds , Fibrinogen Degradation (FDP)> 40 mg / d1, Fibrinogen