| 邱君克,毛敏杰,汪彩红,徐节坤.原发性免疫缺陷患者播散性卡介苗病一例及文献复习[J].浙江中西医结合杂志,2015,25(9): |
| 原发性免疫缺陷患者播散性卡介苗病一例及文献复习 |
| Disseminated Bacille Calmette-Guérin Disease Following BCG vaccination receiving: one case report and literature review.QIU Junke, MAO Minjie, WANG Caihong, XU Jiekun. Department of ICU of tuberculosis, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou(31003), China |
| 投稿时间：2014-11-20 修订日期：2015-01-21 |
| DOI： |
| 中文关键词: 原发性免疫缺陷病 卡介苗 播散性卡介苗病 |
| 英文关键词:Primary immunodeficiency Bacille Calmette-Guérin Disseminated Bacille Calmette-Guérin Disease |
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| 中文摘要: |
| 目的 提高对原发性免疫缺陷病所致播散性卡介苗病的认识,提高其诊断水平。方法 回顾性分析浙江省中西医结合医院结核病诊治中心1例经病理确诊的播散性卡介苗病病例并进行相关文献复习。结果 患者女,8月,因接种卡介苗后出现“左肩部溃烂5月,左腋下肿块2月”于2008年7月15日入住我院普外科。入院后行左腋下脓肿切排和淋巴结活检术。术后病理结果：(左腋下淋巴结)大片类上皮细胞、淋巴细胞及多量中性粒细胞,符合结核性炎,抗酸染色强阳性。B超提示全身浅表淋巴结肿大。血免疫学检查：IgA <0.0667g/L,IgM 0.05g/L, IgG <0.333g/L, C3 1.28g/L, C4 0.44g/L；血淋巴细胞亚群：CD3 41.6%, CD4 30.1%, CD8 8.7%, CD19 0.3%, CD4/CD8 3.46, CD16 56 55.4%。目前国外对原发性免疫缺陷病引起的播散性卡介苗病报道较多,常用的筛查方法包括用TREC试验来筛查严重联合免疫缺陷,四唑氮蓝还原试验筛查慢性肉芽肿病。国内新生儿出生后普遍接种卡介苗,尚未开展相关筛查措施。结论 对接种卡介苗后出现严重并发症的患儿应高度警惕其罹患原发性免疫缺陷病可能。加强对新生儿原发性免疫缺陷病筛查是避免对免疫缺陷患儿接种卡介苗导致播散性卡介苗病的重要措施。 |
| 英文摘要: |
| Objective To improve the knowledge and diagnosis of disseminated BCG disease (BCGosis) caused by primary immunodeficiency disease. Methods A retrospective analysis of one case of BCGosis and literature review were conducted. Results A 8-month old girl was admitted because of left shoulder skin ulcers, left armpit lumps to Department of General Surgery in Integrated Chinese and Western Medicine Hospital of Zhejiang Province. Left axillarySabscessSincision and drainageSand lymphSnode biopsy was performed and the pathology result suggested tuberculous spondylitis and acid-fast staining (4 ). B-ultrasonicsSshowedSdiffuseSenlarged superficial lymphSnode. Immunologic examination indicated serum IgA <0.0667g/L, IgM 0.05g/L, IgG <0.333g/L, complement C3 1.28g/L and C4 0.44g/L. At present BCGosis caused by primary immunodeficiency disease was reported so many and screened by some measures in some countries. Newborn screening for severe combined immunodeficiency using assays to detect T-cell receptor excision circles (TRECs) and for chronic granulomatous disease using nitroblue tetrazolium test. There were few reports about BCGosis caused by primary immunodeficiency disease and measures to screen it in our country, though the newborn were generally vaccinated BCG after birth. Conclusions Occurrence of severe BCG complications in children may strongly suggest the diagnosis of primary immunodeficiency. It is necessary to strengthen screening of primary immunodeficiency and avoid administration of BCG at birth in those newborn. |
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