The 466th case: myasthenia, fever, blurred vision and pancytopenia
10.3760/cma.j.issn.0578-1426.2018.12.015
- VernacularTitle:第466例——肌无力、发热、视物模糊、血三系减少
- Author:
Guangchan JING
1
;
Yang CHEN
;
Li WANG
;
Dong XU
;
Wenjie ZHENG
;
Mengtao LI
;
Xiaofeng ZENG
;
Fengchun ZHANG
Author Information
1. 100730,中国医学科学院北京协和医学院北京协和医院中医科
- Keywords:
Lupus erythematosus,systemic;
Cytomegalovirus;
Lymphohistiocytosis,hemophagocytic
- From:
Chinese Journal of Internal Medicine
2018;57(12):942-944
- CountryChina
- Language:Chinese
-
Abstract:
A 45-year-old woman was admitted to the Department of Rheumatology and Immunology, Peking Union Medical College Hospital, due to weakness of the upper limbs, fever, and blurred vision. She was clinically diagnosed as systemic lupus erythematosus overlapped primary biliary cirrhosis, with renal, retinal, hematological and musculoskeletal involvement, combined with severe pulmonary infection and respiratory failure. Treated with glucocorticoids, ursodeoxycholic acid, antibiotics and respiratory support, the patient got better. A couple of days later, her fever recurred and platelets count dropped to 30×109/L, hemoglobin to 78 g/L, fibrinogen to<1.5 g/L, ferritin to 1 640 ng/ml, natural killer (NK) cell count to 8/μl, the activity of NK cells 2% (reference value 9.5%-23.5%), considering the occurrence of hemophagocytic lymphohistiocytosis (HLH). Cytomegalovirus pp65 antigenemia test: 13 positive cells/2×105 WBC. Considered the possibility of HLH caused by cytomegalovirus infection and treated by 250 mg ganciclovir intravenous drip twice a day for a full course. The temperature of the patient was gradually reduced to 36.5℃, the count of platelets were increased to 229×109/L, the hemoglobin was increased to 94 g/L, and the fibrinogen was increased to 3.26 g/L. When there were unexplained critical signs of the primary disease during systemic lupus erythematosus treatment, severe complications such as infection, HLH, thrombotic thrombocytopenic purpura should be taken into account.
