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目的报告1例狂犬病疫苗接种后发生腹型过敏性紫癜,为处理此类事件提供参考。方法调查该患者疫苗接种过程及出现的临床反应,收集诊治过程与随访资料,分析与疫苗接种的关系。结果患者接种第4剂次狂犬病疫苗1 h后,即出现腹部持续性绞痛,呕吐咖啡色胃内容物约100 m L,上腹有压痛,双下肢及臀部皮肤可见散在出血点,双手指皮肤发黑;肠镜显示直肠弥漫性充血水肿,回肠末端点片状充血糜烂;呕吐物隐血阳性(++),大便隐血阳性(++++),血常规WBC 11.42×109/L,N 79.1%,L 18.8%,PLT 118×109/L,活化部分凝血酶时间38.1 s,D-二聚体28 460 mg/L,符合过敏性紫癜(腹型)的临床诊断,且患者发病与疫苗接种存在时间关联。结论该患者可能为接种狂犬病疫苗引起的腹型过敏性紫癜,应及早防范、及时发现、及时处置。
Objective To report the occurrence of anaphylactoid purpura after a rabies vaccine inoculation in order to provide references for the treatment of such events. Methods To investigate the course of vaccination and the clinical response, collect the diagnosis and follow-up data, and analyze the relationship with the vaccination. Results Persistent abdominal cramps were observed in patients with rabies vaccination after the first dose of rabies vaccine for 4 hours. The contents of brown stomach in vomit were about 100 m L, with tenderness in the upper abdomen. Bleeding points were found in the skin of both lower extremities and buttocks. Black; colonoscopy showed rectal diffuse hyperemia and edema, terminal ileal punctate hyperemia erosion; vomit occult blood positive (++), fecal occult blood positive (++++), blood WBC 11.42 × 109 / L, N79.1% , L 18.8%, PLT 118 × 109 / L, activated partial thrombin time 38.1 s, D-dimer 28 460 mg / L, in line with the clinical diagnosis of Henoch-Schonlein purpura (abdominal type), and the incidence of patients and vaccination exist Time related. Conclusion The patient may be vaccinated rabies vaccine caused by abdominal Henoch-Schonlein purpura should be prevented as soon as possible, timely detection, timely disposal.