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报告2例姐弟先后患紫色色杆菌脓毒血症。例1.患儿女(姐姐),6岁。皮肤科检查:左腘窝下一4 cm×2 cm不规则溃疡面,表面可见黄色脓性分泌物和新生肉芽肿,周围肿胀。实验室及辅助检查:血常规中WBC 15.36×109/L,白细胞分类:N0.75,血涂片示中性粒细胞增多伴中毒性改变。分泌物及淋巴结穿刺液细菌培养示紫色色杆菌生长。彩超示多发性肝、脾脓肿。诊断:紫色色杆菌脓毒血症、多脏器脓肿。治疗:予静脉滴注头孢哌酮/舒巴坦(1.5 g,每日2次)抗感染,29 d后出现高热伴惊厥、腹痛及咳嗽,多脏器脓肿救治无效死亡。例2.患儿男(弟弟),5岁。皮肤科检查:双下肢散在分布数个大小不等暗红色肉芽肿样结节伴小脓疱,部分形成溃疡,周围有炎性浸润性红晕,双侧腹股沟触及增大的淋巴结伴压痛。实验室及辅助检查:血常规中WBC 29.39×109/L,N 0.86;降钙素原6.48μg/L,分泌物细菌培养示紫色色杆菌生长。诊断:紫色色杆菌脓毒血症。治疗:予静脉滴注亚胺培南(0.5 g,每日2次)和头孢哌酮/舒巴坦(1.5 g,每日2次),补液及对症支持,治疗20 d后患者双下肢溃疡结痂完全脱落,各项实验室检查均恢复正常。随访2年,病情无复发。
Two siblings reported suffering from purple Chlamydia sepsis. Example 1. Children with children (sister), 6 years old. Dermatology examination: Left popliteal fossa ulcer 4 cm × 2 cm irregular surface, the surface can see yellow purulent discharge and neonatal granuloma, swollen around. Laboratory and laboratory examinations: blood WBC 15.36 × 109 / L, white blood cell classification: N0.75, blood smears showed neutrophilia with toxic changes. Secretion and lymph node puncture fluid bacterial growth showed purple Chromobacterium growth. Choi ultrasound shows multiple liver, spleen abscess. Diagnosis: Chromobacterium purpurae sepsis, multiple organ abscess. Treatment: intravenous cefoperazone / sulbactam (1.5 g, 2 times a day) anti-infection, fever and convulsion after 29 d, abdominal pain and cough, multiple organ abscess treatment died. Example 2. Children male (brother), 5 years old. Dermatology examination: the distribution of both lower extremities ranging in size from a few dark red granulomatous nodules with small pustules, the formation of ulcers, surrounded by inflammatory infiltrating flush, bilateral groin touches increased lymphadenopathy and tenderness. Laboratory and laboratory examinations: blood routine WBC 29.39 × 109 / L, N 0.86; procalcitonin 6.48μg / L, the secretion of bacterial culture showed the growth of purple fungus. Diagnosis: Chromobacterium purpurae sepsis. Treatment: imipenem (0.5 g twice daily) and cefoperazone / sulbactam (1.5 g twice daily) were given intravenously, and fluid replacement and symptomatic support were given. After 20 days of treatment, patients with both lower limb ulcers Scab completely off, all laboratory tests returned to normal. Follow-up 2 years, no recurrence of the disease.