12岁女孩急性发热伴双下肢皮疹、坏死、大疱

Acute fever with rash, necrosis, and bullae in both lower extremities in a 12-year-old girl

摘要:

12岁女性患儿，因发热、皮疹3 d入院。患儿3 d前出现反复高热及双下肢皮疹，左下肢皮疹于24 h之内迅速融合成片、中心出现蓝黑色出血性坏死及水疱。病程中出现PLT降低、纤维蛋白原及D-二聚体明显升高，确诊为暴发性紫癜。予美罗培南联合利奈唑胺抗感染、丙种球蛋白调节免疫、低分子肝素抗凝，将皮疹水疱处液体抽出、保护皮疹处伤口创面、防止感染等处理，患儿无发热，坏疽皮肤好转，PLT、纤维蛋白原及D-二聚体正常后出院。暴发性紫癜是一种罕见的、病情进展迅速的血栓性出血性疾病，多见于儿童。如不及时处理，可造成严重后遗症，致残率及病死率高。在治疗过程中，抗感染、纠正凝血功能、坏疽皮肤的局部管理至关重要。

Abstract:

A girl, aged 12 years, was admitted due to fever and rash for 3 days. The child developed recurrent high fever and rash on both lower extremities 3 days before, and the rash on left lower extremity quickly merged into a patch within 24 hours, with hemorrhage and necrosis in black and purple, large vesicles, and blisters in the center. Laboratory examination showed a reduction in platelet count and significant increases in fibrinogen and D-dimer during the course of the disease. The child was diagnosed with purpura flulminans. She was given meropenem combined with linezolid for anti-infection, injection of gamma globulin for immunoregulation, and low-molecular-weight heparin for anticoagulation. The fluid in the rash blisters was drawn and the wound was treated to prevent infection. The child's temperature returned to normal, with improvement in gangrene. She was discharged after platelet count, fibrinogen, and D-dimer had returned to normal. Purpura fulminans is a rare thrombotic hemorrhagic disease with rapid progression and is commonly seen in children. Without timely treatment, it may cause severe sequelae with high disability and mortality rates. Anti-infection, correction of coagulation function, and local management of gangrene skin are of great importance during treatment.