爆发型多发性肌炎并发急性肾损伤1例

多发性肌炎（polymyositis,PM）是一种骨骼肌非化脓性炎症性疾病。其主要临床表现是对称性四肢近端肌无力,常伴有全身症状。该病临床表现多样,大多起病缓慢,极少数急性起病。暴发型多发性肌炎临床罕见,并发急性肾损伤,合并横纹肌溶解、肌红蛋白尿,甚至有类似急性冠脉综合症的临床表现,病死率较高。对于该类患者,早期明确诊断,积极治疗显得尤为重要。本文就临床工作中接诊的一例爆发型多发性肌炎患者展开讨论,旨在分享临床诊疗工作中的心得体会。1临床资料     

进行性多发性骨化性肌炎

进行性多发性骨化性肌炎,是一种多发于幼儿,连续或间断的使随意肌、肌膜、腱、腱膜骨膜、韧带等发生进行性骨化,最后全身变成僵硬的一种疾病。国外于1740年Freke首先报导。1858年Muenchmyer报导过18例并做了分析。1898年Stempell曾分析44例文献。1912年後藤经过多次病理检查,倡用进行性骨化性肌膜增殖症之名。以后宫崎、浦上等,详细报告了有关本症的病理解剖,到目前为止国内外文献尚不满200例。国内有关本症的报导甚少。     

多发性肌炎1例报告

患者男，２５岁。因胸痛，伴有胸闷、心悸１月余于２００２－０５－１９以心肌炎收入院。患者于１月前，因“感冒”出现头晕、头痛，全身肌肉酸痛、乏力，食欲下降，经服用“感冒药”治疗，上述征象好转，继而出现胸部隐痛，范围涉及整个心前区，不向其它部位放射，伴有心悸、胸闷，劳动或过度活动时加重，休息数分钟后减轻，无发热、咳嗽。在当地医院，初诊为心肌炎，给予抗生素，改善心肌细胞代谢、缓解疼痛等药物治疗，未见明显改善，后逐渐出现腹肌及四肢肌肉疼痛，反复发作，此起彼伏，时轻时重，全身乏力，肌痛尤以上楼或起立时加剧。…     

多发性肌炎误诊1例

病历介绍患者,男,20岁,河北籍,某部战士。主因四肢无力一周,于1983年5月30日入院。自述于5月23日早晨起床时感右上肢无力,不能上举。三天后感左上肢无力,五天后双下肢亦感无力,上楼需别人扶助。发病前后无发热、肌肉疼痛、咽痛、腹泻等不适,亦无晨轻下午重现象。无头颈部外伤史。不伴有眼睑下垂、吞咽及呼吸困难,二便如常。本单位按“周期性麻痹”给于补钾治疗两天无效,故转来我院。既往体健,无传染病及药物、阳光过敏史,亦无类似发作史,     

多发性肌炎诊治及预后

目的探讨多发性肌炎的诊断及预后与皮质类固醇激素（以下简称激素）应用、合用免疫抑制剂及酶学改变的关系。方法将本院2000年8月至2006年2月收治的多发性肌炎33例按是否复发分为两组,无复发组24例,复发组9例,分析两组间激素应用总量、合用免疫抑制剂的关系。结果两组间应用激素总量、治疗时间上均有明显差异,预后与是否合用免疫抑制剂无关。结论多发性肌炎诊断相对容易,治疗有公认的标准,预后与激素用量、治疗时间成正相关。     

多发性肌炎1例报道

病例 :女 ,２３岁 ,因畏寒发热头痛４日 ,伴有四肢酸痛入院。发病前患者曾有少许咳嗽、咳痰、鼻塞、流清涕 ,后开始发热 ,体温在３８℃～３９℃之间波动 ,曾在门诊静滴“青霉素及病毒唑”未见好转 ,于第４日入院。入院查 :Ｔ :３６ ８℃ ,神清 ,精神萎靡 ,未见黄染、皮疹、皮下结节。全身浅表淋巴结未触及。颈软 ,扁桃体无肿大 ,咽部无充血。心肺腹体检均无异常发现。脊柱四肢无畸形。各关节无红肿、压痛、僵硬及活动受限 ,双上肢无水肿。入院当日患者体温升高至４０℃ ,血常规ＷＢＣ３ ８×１０９／Ｌ ,余各项正常 ,未查到疟原虫。患者入院…     

肌炎特异性抗体与多发性肌炎/皮肌炎的研究进展

多发性肌炎和皮肌炎是骨骼肌受累为主要表现的自身免疫性疾病,通常合并其他器官系统损害,包括关节、肺、心脏、胃肠道等.除了临床症状、体征、血生化、肌电图及肌肉病理诊断方法外,进行肌炎抗体检测也很有必要.多发性肌炎/皮肌炎病人所存在的多种肌炎抗体对疾病的诊断、临床分型、判断疾病活动度、预后均有一定的帮助.     

多发性肌炎16例临床分析

多发性肌炎因首发症状缺少特异性,易延误诊治。本文收集了大连医学院附属一院近十年来共16例多发性肌炎病历,对比观察了不同的临床表现及血清酶、抗体、补体 C_3,24小时尿肌酸等实验室检查,试图达到早期诊治目的。现做以如下分析。1 临床资料1.1 一般资料:本组16例中,男6例,女10例。年龄20-30岁6例,30-50岁10例。病程15天至10年,半年以上者9例(55.5％)。     

多发性肌炎2例误诊分析

1病例报告 例1，患者，女，36岁，于3年前无明显诱因感四肢无力，易疲劳。在当地医院查血钾3．1mmol／L，诊断“周期性麻痹”。给予静脉及口服补钾等治疗，自觉症状好转。此后每年均反复发作4—6次不等，有时自行补钾或到医院给予补钾，症状均有好转，但发病后渐出现消瘦，体力劳动逐渐丧失，     

多发性肌炎26例临床分析

目的 分析多发性肌炎临床特点及治疗方法.方法 选取临床 2010年 1月 ~2013年 6月收治的 26例多发性肌炎皮质类固醇及免疫抑制剂治疗的方法及临床资料进行分析.结果 治疗时间 23~70 d,平均 47 d;肌力达 3级占 9例,4级 11例,5级 4例,肌力恢复 3级或 3级以上者 24例,占92.3%.结论 经皮质类固醇治疗后症状改善,也有许多患者遗留不同程度的肩部、臀部肌无力.     

特布他林致急性尿潴留

特布他林(博利康尼,Bricanyl)是一种选择性肾上腺素β2受体激动剂.用于支气管哮喘,慢性支气管炎,肺部疾病引起的支气管痉挛,治疗效果显著.不良反应较少见,笔者在临床工作中遇到博利康尼引起急性尿潴留1例,现报告如下.     

Diffuse ulcerations due to disseminated histoplasmosis in a patient with HIV

Disseminated histoplasmosis is a serious disease that affects the skin, lungs, and internal organs. It is one of the diseases that characterize acquired immunodeficiency syndrome (AIDS), and in endemic areas is one of the more commonly observed infections in AIDS patients. The mortality rate in patients with AIDS and histoplasmosis is high if untreated. Disseminated histoplasmosis may have a variety of dermatological manifestations. In this article, we provide the first report of diffuse ulcerations due to disseminated histoplasmosis. These ulcers developed while the patient was on stavudine, lamivudine, and indinavir, and had a CD-4 count of 525 mm3. The patient's histoplasmosis resolved with itraconazole monotherapy. Histoplasmosis is a well-described opportunistic infection that accompanies human-immunodeficiency virus (HIV) infection. We report an unlikely victim of disseminated histoplasmosis who suffered this infection while on antiretroviral therapy and with a CD-4 count of 525/mm3. Notably, he had a normal chest x-ray and disseminated cutaneous ulcers. The diagnosis was made by skin biopsy, and his infection responded promptly to itraconazole therapy. This case serves as a reminder that the immunological derangements and cutaneous alterations wrought by HIV remain unpredictable in nature and extent.     

甲泼尼龙冲击治疗骨化性肌炎1例

目的 :观察甲泼尼龙冲击疗法对进行性骨化性肌炎的治疗作用。方法 :对 1例经临床和病理确诊的进行性骨化性肌炎病人给予甲泼尼龙冲击1.0 g ,iv ,gtt ,qd ,共 7d。结果 :病变肌肉水肿明显减退 ,疼痛明显减轻 ,效果显著。结论 :甲泼尼龙对改善进行性骨化性肌炎病灶水肿 ,缓解病情具有明显疗效     

Hemopericardium in a patient treated with dabigatran etexilate

Dabigatran etexilate is a new oral anticoagulant used for the prevention of systemic thromboembolism in patients with atrial fibrillation. Acute bleeding episodes are known to occur with dabigatran etexilate therapy; however, only a few case reports in the literature describe such events. We describe a 70-year-old man treated with dabigatran etexilate for newly diagnosed, nonvalvular atrial fibrillation who developed a large hemopericardium that appeared to be temporally related to dabigatran etexilate administration. One month after starting the drug, an incidental finding of a small pericardial effusion was found on echocardiography. One month later, the patient came to his pulmonologist's office complaining of shortness of breath; a large pericardial effusion was found on a noncontrast computed tomographic scan, and the patient was admitted to the hospital. Laboratory monitoring of his coagulation status was limited due to the lack of assays available to directly monitor the therapeutic effects of dabigatran. The internal laboratory was able to perform a dilute thrombin time (DTT) test as part of a quality improvement project aiming to validate an assay for monitoring patients receiving dabigatran therapy. A DTT was therefore performed in conjunction with routine coagulation assays to evaluate the patient's coagulation status. After pericardiocentesis, the patient recovered without incident and was discharged without anticoagulant therapy. Although the Naranjo adverse reaction probability scale only indicated a possible relationship (score of 1) between the patient's development of hemopericardium and dabigatran etexilate therapy, investigation into the patient's clinical course, comorbidities, and laboratory results led us to conclude that dabigatran etexilate was responsible for the hemopericardium. To our knowledge, this report is the first to describe a case of potentially life-threatening pericardial bleeding that was temporally related to starting dabigatran etexilate therapy. Although we found that the DTT was a viable method of monitoring coagulation status in a patient receiving dabigatran etexilate therapy, the assay lacks approval by the United States Food and Drug Administration, which limits its clinical utility and widespread use at this time. Clinicians should be aware of the potential for life-threatening bleeding with use of this agent and the difficulty associated with monitoring and reversing this therapy in the setting of acute bleeding.     

Pigmentary changes in a patient treated with imatinib

Imatinib mesylate (STI 571; Gleevec; Novartis Pharmaceuticals, Basel, Switzerland) is an orally available tyrosine kinase inhibitor that targets a constitutively activated BCR-ABL tyrosine kinase with additional inhibitory effects on platelet derived growth factor (PDGF) receptors alpha and beta, and KIT. It has revolutionized the treatment of adult and pediatric patients with Philadelphia chromosome positive chronic myelogenous leukemia (CML) and is also FDA-approved for KIT-positive advanced gastrointestinal tumor (GIST) and dermatofibrosarcoma protuberans. A wide spectrum of dermatologic toxicities has been associated with this agent, among which a maculopapular rash is the most common event. In addition, a variety of pigmentary abnormalities of the skin and mucosal surfaces have been reported. Hypopigmentation is a well-recognized adverse effect. In contrast, paradoxical hyperpigmentation has only rarely been documented. In this case report we describe imatinib-induced cutaneous hyperpigmentation and graying of hair occurring in the same patient with dermatofibrosarcoma protuberans treated with imatinib.     

Psoriasiform dermatitis in a non-psoriatic patient treated with adalimumab

Anti-TNF drugs may be associated with various adverse reactions including cutaneous ones. We describe the case of a 45-year-old woman affected by undifferentiated spondyloarthritis who presented a localized psoriasiformis dermatitis during treatment with adalimumab, without any medical history of psoriasis.     

干扰素治疗丙型肝炎患者引起房颤

患者男,69岁。2001年经检查发现感染丙型肝炎病毒,于2003年10月15日来我院治疗。化验检查:HCV-RNA1.88×106 copies/mL(正常值<2×102 copies/mL),ALT78U/L。既往病史:1984年因支气管扩张并咯血,曾输血400mL;1989年因左肾结石切除左肾。在此之后肝功反复异常,ALT波动于100～200U/L。患者既往最高血压为150/90mmHg(1mmHg=0.133kPa),无心脏疾病史。为治疗丙型肝炎,给予干扰素α(英特龙)300万u,肌内注射,1次/d治疗。在注射第1针干扰素后0.5h左右,患者突然出现心慌、头晕、发热、面色苍白。查体:T38.8℃,BP120/80mmHg,P140次/min,R2…