血栓性血小板减少性紫癜(TTP)是一种罕见且可能致命的疾病。大多数病例是由血液中的显着酶缺乏引起的,称为vonWillebrand因子(VWF)裂解蛋白酶(也称为ADAMTS13)。由于高死亡率,TTP被归类为血液学紧急情况。由于TTP和其他疾病的临床表现广泛重叠,因此诊断困难。肺炎克雷伯菌感染可在非常罕见的情况下出现TTP和/或患者可能患有前列腺的转移样表现,肝脏,大脑,和模仿晚期实体器官恶性肿瘤的肺脓肿。在本文中,我们报告一例38岁男性患者肺炎克雷伯菌感染继发TTP,发烧的人,咳嗽,还有五天的呼吸急促.在检查中,他非常不稳定,困惑,没有导向,格拉斯哥昏迷量表(GCS)为9/15。全血细胞计数(CBC)显示高白细胞(WBC)计数,血小板计数非常低,网织红细胞计数增加,外周血膜上的分裂细胞显著升高。痰和血培养均为肺炎克雷伯菌阳性。计算机断层扫描(CT)扫描胸部显示双肺实质结节。腹部超声(US)扫描检测到右肝叶病变,囊性和实性。病人最初开始服用美罗培南,万古霉素,和左氧氟沙星由于休克表现,后来降级为头孢曲松。患者进行了五次治疗性血浆交换,并开始使用甲基强的松龙三天。患者的情况逐渐好转,他后来出院了.第二例是一名63岁的男性患者,他发烧,干咳,盗汗,还有七天的排尿困难.他非常稳定,有意识,警报,和导向。他的血红蛋白为9.6g/dl。他计划进行紧急结肠镜检查以排除结肠癌以及胸部计算机断层扫描(CT)扫描,腹部,还有骨盆.CT扫描显示复杂的囊性病变累及肝右叶,肺,肾上腺,还有前列腺.临床表现提示高粘液样肺炎克雷伯菌感染向肝脏淋浴,肾上腺,还有前列腺.引流前列腺收集和尿液培养证实了诊断。除头孢曲松和甲硝唑外,还对患者进行了手术引流。该患者在环丙沙星方面身体健康,并进行了门诊随访。
Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially fatal disease. The majority of cases are caused by a significant enzyme deficiency in the blood called the von Willebrand factor (VWF) cleaving protease (also called ADAMTS13). TTP is classified as a hematologic emergency because of the high mortality rate. The diagnosis is difficult due to the extensive overlap in the clinical manifestations of TTP and other illnesses. Klebsiella pneumoniae infection can in very rare instances present with TTP and/or a metastatic-like presentation where the patient might have prostate, liver, brain, and lung abscesses mimicking late-stage solid organ malignancy. In this paper, we report a
case of TTP secondary to Klebsiella pneumoniae infection in a 38-year-old male patient, who presented with fever, cough, and shortness of breath for five days. On examination, he was vitally unstable, confused, and not oriented, with a Glasgow Coma Scale (GCS) of 9/15. Complete blood count (CBC) showed a high white blood cell (WBC) count, very low platelet count, increased reticulocyte count, and significant elevation of schistocytes on peripheral blood film. Sputum and blood cultures were positive for Klebsiella pneumoniae. Computerized tomography (CT) scan chest showed bilateral lung parenchymal nodules. An abdominal ultrasound (US) scan detected a right hepatic lobe lesion that was both cystic and solid. The patient was initially started on meropenem, vancomycin, and levofloxacin due to shock presentation which was de-escalated to ceftriaxone later. The patient had five therapeutic plasma exchange sessions and was started on methylprednisolone for three days. The patient\'s situation gradually improved, and he was discharged later on. The second
case is a 63-year-old-male patient who presented with fever, dry cough, night sweats, and dysuria for seven days. He was vitally stable, conscious, alert, and oriented. His hemoglobin was 9.6 g/dl. He was scheduled for an urgent colonoscopy to rule out colon cancer along with computed tomography (CT) scan of the chest, abdomen, and pelvis. The CT scan showed complex cystic lesions involving the right hepatic lobe, lungs, adrenal glands, and prostate. The clinical picture was suggestive of hyper-mucoid Klebsiella pneumoniae infection showering to the liver, adrenal glands, and prostate. A drained prostate collection and urine cultures confirmed the diagnosis. The patient was managed with surgical drainage of the collection in addition to ceftriaxone and metronidazole. The patient was discharged in good health on ciprofloxacin with follow-up as an outpatient.