传染性单核细胞增多症合并手足口病1例

[摘要]?儿童传染性单核细胞增多症（infectious mononucleosis, IM）合并手足口病（hand, foot and mouth disease, HFMD）病例较少见。本文报道1例儿童IM合并HFMD病例。患儿男，年龄为3岁8个月，因发热、皮疹入院。病原学检查结果：EB病毒（Epstein-Barr virus, EBV）早期抗原IgG 阳性，EBV VCA抗体IgM 阳性，EBV VCA抗体IgG 阳性，EBV核心抗原IgG 阴性。血清EBV DNA检测结果：1.31×105/ml。咽拭子HFMD病原体核酸检测结果：肠道病毒通用型定性检测阳性。血常规结果：白细胞计数20.47×109/L，淋巴细胞总数 18.03×109/L，淋巴细胞比例 88.1%，外周血细胞形态检测显示异性淋巴细胞约占20%。血ALT 248 U/L。肌酸激酶同工酶-MB 50 U/L，乳酸脱氢酶 576 U/L，AST 128U/L。乳酸脱氢酶同工酶-1 105 U/L。诊断为 IM；HFMD；肝功能受损，心肌损害。患儿入院后予以头孢美唑抗感染、更昔洛韦抗病毒，同时给予护肝、营养心肌等对症支持治疗，住院治疗5 d，病情较前明显好转出院。出院后继续巩固治疗，出院1周后复查各项指标逐渐回复正常，出院3周后复查各项指标恢复正常，但是EBV DNA定量为 5.98×104拷贝/ml。该个案提示：对于临床上确诊为HFMD的患儿，如果血常规显示白细胞计数较高，分类里以淋巴细胞比例高为主，需警惕合并IM；另外如果患儿反复发热时间长，也需要警惕合并IM的可能。     

A young boy with rash,arthritis, and developmental delay: Monogenic lupus due to DNASE2 gene defect

Monogenic causes are increasingly being recognized in patients with lupus, especially in early-onset disease. We herein report a boy with a novel mutation in the DNase 2 (DNASE2) gene presenting with monogenic lupus. A 6-year-old boy with a global developmental delay with microcephaly presented with chronic febrile illness with anemia, rash, polyarthritis, renal involvement, and hepatosplenomegaly. Laboratory investigations revealed positive antinuclear antibody, high anti-dsDNA antibody titers, hypocomplementemia, hypergammaglobulinemia, nephrotic range proteinuria, and diffuse proliferative glomerulonephritis. Magnetic resonance imaging of brain showed altered signal intensity in subcortical white matter in bilateral fronto-parieto-temporal lobes. Targeted next-generation sequencing revealed a novel pathogenic variant in DNASE2. He was treated with oral prednisolone, mycophenolate mofetil, cyclosporine, and hydroxychloroquine and is doing well on follow up. DNASE2 deficiency has been reported as a rare genetic cause of monogenic lupus. DNASE2 deficiency should be suspected in patients with early-onset lupus with polyarthritis, erythematous rash, and neurological involvement.     

COVID-19 and cutaneous manifestations: A review of the published literature

Background

COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID-19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020.

Aim

Skin manifestations related to SARS-CoV-2 infection can be divided mainly into five groups: chilblainlike lesions (CBLLs), maculopapular eruptions, urticarial eruptions, vesicular eruptions, and livedo or necrosis. Other skin findings reported are erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C) and rarely with multisystem inflammatory syndrome in adults (MIS-A). Other manifestations such as pityriasis rosea or shingles are also reported.

Methods

A total of 60 articles including reviews, studies and case reports were selected for the evaluation in this review.

Results

The skin manifestations associated with COVID-19 infection are numerous and can vary widely. The major dermatological patterns of COVID-19 can be classified as inflammatory reactions (maculopapular/morbilliform, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo acemose-like pattern)

Conclusion

We believe that the dermatologist could play an important role in the response to the SARS-CoV-2 pandemic through early recognition of skin lesions suggestive of COVID-19, particularly in paucisymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis.     

感染性皮疹的诊断思路

感染性疾病在病程中会伴有皮疹,本文对引起皮疹的疾病、皮疹的形状和特征及临床和实验室检查进行综述.