Management of elderly patients with acute infectious fulminant purpura and septic shock caused by Streptococcus pyogenes
10.3969/j.issn.1008-9691.2024.01.021
- VernacularTitle:化脓性链球菌致急性感染性暴发性紫癜合并脓毒性休克老年患者的救治实践
- Author:
Zongzhao HE
1
;
Bin SUN
;
Siqing MA
;
Litao GUO
;
Hao WANG
Author Information
1. 青海省人民医院重症医学科,青海西宁 810007
- Keywords:
Streptococcus pyogenes;
Acute infection;
Fulminant purpura;
Sepsis;
Treatment
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(1):95-99
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the clinical manifestations of elderly patients with acute infectious purpura fulminant(AIPF)and septic shock caused by Streptococcus pyogenes(GAS),analyze the changes in indicators and treatment processes,and provide clinical references for the diagnosis and treatment of such diseases.Methods A retrospective analysis was conducted on the case data,clinical manifestations,signs,examination indexes and treatment process of an elderly patient who presented with GAS-induced AIPF combined with septic shock and was treated by the department of critical care medicine of Qinghai Provincial People's Hospital on June 17th,2021.This study also involved a discussion on the pathophysiological characteristics and treatment measures for these diseases as well as observation of patient prognosis.Results The 80-year-old male patient,who was previously in good health,underwent knee surgery one year ago and was admitted to the hospital on June 17,2021 due to"pain and swelling of the left face with difficulty opening the mouth for the past 2 days".Upon admission,a complete set of laboratory tests including blood routine,blood biochemistry and coagulation function were conducted.A head CT revealed swelling of the masseter muscle on the left side,subcutaneous exudation of the cheek,non-cyanotic space on the left parapharyngeal space,poor display of eustachian tube opening,and narrow throat.Color ultrasound showed soft tissue swelling and interstitial edema in the left maxillofacial region and eyelid.Six hours after admission,the patient gradually developed purple spots,blood scars and necrosis on the right side neck shoulder and upper chest accompanied by tenderness and high fever mainly on his face.The heart rate fluctuated around 150 times per minute while blood pressure was at 108/71 mmHg(1 mmHg≈0.133 kPa,Metaraminol 6.67 μg·kg-1·min-1).The patient was diagnosed with septic shock and transferred to intensive care unit(ICU)for emergency treatment.With timely comprehensive monitoring in place,the patient received active treatment focused on maintaining respiratory circulation stability.After plasma infusion,early wound treatment,reasonable anti-infection measures as well as inflammation clearance,organ function protection,and supportive therapy,the patient eventually recovered from hospitalization without recurrence after 6 months follow-up.Conclusion The onset of acute GAS infection is characterized by its rapid and severe progression,high mortality,and challenging treatment.However,timely and effective refined comprehensive monitoring,evaluation,and treatment can still yield favorable outcomes.
