摘要
目的探讨单核细胞增生李斯特菌感染性脑膜炎的临床表现及治疗措施。方法对1例系统性红斑狼疮并单核细胞增生李斯特菌感染性脑膜炎患者的临床表现、辅助检查、诊断与治疗经过进行分析,讨论其临床特征。结果患者女性20岁,关节疼痛8月,眼睑水肿6月,胸闷2月,1月前诊断为系统性红斑狼疮,给予激素及免疫抑制剂治疗,1w前出现发热、头痛、恶心、呕吐,曾考虑狼疮脑病,给予短暂激素、丙种球蛋白冲击治疗,血液及脑脊液培养提示分离出单核细胞增生李斯特菌,给予美罗培南联合青霉素治疗3w,后序贯青霉素治疗2w,复方磺胺甲噁唑口服2w,患者完全康复。结论单核细胞增生李斯特菌脑膜炎临床少见,误诊率高,病死率高。一旦确诊,应给予早期、足量、足疗程的抗生素治疗。
Objective To explore the clinical features and treatment of listeria monocytogenes meningitis. Method A rare case manifesting systemic lupus erythematosus （ SLE ） and listeria monocytogenes meningitis was reported. Her clinical presentation, laboratory results, diagnosis and treatment were discussed. The relevant literature was reviewed. Results The patient, a 20-year-old girl, presenting arthralgia for 8 months, eyelid edema for 6 months and chest tightness for 2 months, was diagnosed SLE last month. She required treatment with hormone eortisol and immunosuppressive agents. She was admitted with sudden onset headache, fever, nausea, vomiting one week ago. She had considered lupus encephalopathy, high-dose hormone treatment for 2 days. Then blood and eerebrospinal fluid culture was reported listeria monocytogenes .The illness gradually improved after giving meropenem and penicillin for 3 weeks. Then moved on treatment of penicillin for two weeks, trimethoprim - sulfamethoxazole for two weeks, with complete resolution without sequelae. Conclusion Listeria monocytogenes meningitis was rare with the high rate of misdiagnosis. Once was diagnosed, it should be treated early, full dose, full period antibiotic treatment.
作者
张弥兰
冯淑曼
黄月
张杰文
ZHANG Mi-lan FENG Shu-man HUANG Yue ZHANG Jie-wen.(Department of Neurology, the Henan Province People ~s Hospital, Zhengzhou 410003, China)
出处
《脑与神经疾病杂志》
2017年第9期561-565,共5页
Journal of Brain and Nervous Diseases
