背景:百日咳是由百日咳杆菌引起的高度传染性呼吸道疾病,以剧烈咳嗽为特征,主要影响儿童。我们报告了第一例肋骨多处骨折,腰椎,与成人百日咳博德特氏菌感染引起的严重咳嗽有关的骶骨。
方法:一名49岁女性出现急性胸壁疼痛3周。影像学结果显示肋骨和椎骨多处骨折,以及双侧胸腔积液,心包积液,右侧气胸,左侧咽旁和锁骨下淋巴结肿大。病人的骨密度扫描,自身免疫抗体,骨髓活检,骶骨活检都恢复正常.影像学检查结果未发现实体瘤或活动性TB感染的证据。患者后来回忆起在胸痛发作之前有剧烈咳嗽,几个家庭成员也有类似的症状。她的血液样本被送到了疾控中心,显示百日咳博德特氏菌毒素(PT)IgG滴度为110.68IU/mL。该患者被诊断为百日咳和剧烈咳嗽引起的多发性应力性骨折。进行对症治疗,病人的症状改善了。8周后对患者进行了随访,她报告没有咳嗽或胸痛。
结论:百日咳不仅仅是一种儿科疾病,但是成人的诊断具有挑战性,因为患者可能会出现无数令人困惑的症状,如由于剧烈咳嗽引起的多次应力性骨折。医学和流行病学史是获得正确诊断的关键,这是必要的适当的治疗,以避免进一步的并发症。应建议进行成人免疫,以保护成人人口并防止传播给儿童。
BACKGROUND: Pertussis is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis, characterized by paroxysms of severe coughing, and predominantly affects children. We report the first
case of multiple fractures in the ribs, lumbar spine, and sacrum associated with severe coughing caused by Bordetella pertussis infection in an adult.
METHODS: A 49-year-old female presented with acute-onset chest wall pain for 3 weeks. Imaging results revealed multiple fractures in the ribs and vertebrae, as well as bilateral pleural effusion, pericardial effusion, right pneumothorax, and enlargement of the left parapharyngeal and subclavian lymph nodes. The patient\'s bone density scan, autoimmune antibodies, bone marrow biopsy, and sacral bone biopsy all came back normal. Imaging test results found no evidence of solid tumors or active TB infection. The patient later recalled having violent coughing prior to the onset of chest pain and several family members having similar symptoms. Her blood sample was sent to the CDC, revealing Bordetella pertussis toxin (PT) IgG titer of 110.68 IU/mL. The patient was diagnosed with pertussis and multiple stress fractures from violent coughing. Symptomatic treatments were administered, and the patient\'s symptoms improved. The patient was followed up 8 weeks later, she reported no more coughing or chest pain.
CONCLUSIONS: Pertussis is not just a pediatric disease, but diagnosis in adults is challenging as patients may present with a myriad of confusing symptoms, such as multiple stress fractures due to violent coughing. Medical and epidemiological histories are key to reaching the correct diagnosis, which is essential for appropriate treatments to avoid further complications. Adult immunization should be suggested both for the protection of the adult population and to prevent transmission to children.