糖尿病合并脓毒血症及肝脓肿、眼内炎的诊断学特征

目的探讨糖尿病合并脓毒血症及肝脓肿、眼内炎的诊断学特征。 方法回顾性分析2020年6月8日安徽医科大学第一附属医院内分泌科收治的1例糖尿病合并脓毒血症及肝脓肿、眼内炎患者的临床资料,总结其诊断学特征。 结果患者男性,68岁,因"多尿多饮10年,全身乏力伴发热1周余"入院,既往2型糖尿病10余年。患者1周余前出现全身乏力,恶心呕吐,发热伴寒战,右眼高度肿胀,视物模糊。血常规示WBC 26.52×10⁹/L,嗜中性粒细胞比例0.91;随机血糖23.62 mmol/L;HbA_1c 11.40%;尿常规示葡萄糖(3＋),酮体(3＋),CRP 81.36 mg/L,PCT 3.20 μg/L。血培养示肺炎克雷伯杆菌。腹部CT平扫示肝右叶片状低密度灶,提示肝脓肿。眼部B超示右眼眼内炎、右眼眶蜂窝组织炎。患者诊断为糖尿病酮症酸中毒合并脓毒血症、肝脓肿、眼内炎,考虑为肝脓肿致血源性眼内感染。 结论糖尿病合并脓毒血症及肝脓肿、眼内炎是较为罕见且危重的并发症,临床症状不典型,易漏诊和误诊,应加强对该病的认识做到及时诊治。

Diagnostic features of diabetes with sepsis,liver abscess and endophthalmitis

ObjectiveTo explore the diagnostic features of diabetes with sepsis, liver abscess, and endophthalmitis. MethodsThe clinical data of a patient with diabetes, sepsis, liver abscess, and endophthalmitis admitted to the Department of Endocrinology, the First Affiliated Hospital of Anhui Medical University on June 8, 2020 were retrospectively analyzed, and its diagnostic characteristics were summarized. ResultsThe 68-year-old male patient was admitted to the hospital due to " polyuria and polydipsia for 10 years, general fatigue and fever for more than 1 week" . He has had type 2 diabetes for more than 10 years. The patient developed general fatigue, nausea and vomiting, fever accompanied by chills, blurred vision in the right eye for more than 1 week. Blood routine examination showed WBC 26.52×10⁹/L, and neutrophil ratio of 0.91. Random blood glucose was 23.62 mmol/L, and HbA_1c was 11.40%. Routine urine examination showed glucose (3+ ) and ketone body (3+ ). CRP level was 81.36 mg/L, PCT level was 3.20 μg/L. Blood culture showed Klebsiella pneumoniae. Plain CT scan of the abdomen showed a lobular hypodensity lesion on the right side of the liver, suggesting liver abscess. Ultrasonography showed endophthalmitis and cellulitis in the right orbit. The patient was diagnosed as diabetic ketoacidosis, complicated with sepsis, liver abscess, and endophthalmitis defined as a blood-borne intraocular infection caused by liver abscess. ConclusionsDiabetes combined sepsis, liver abscess and endophal inflammation is a relatively rare and critical complication. The clinical symptoms are not typical and it is easily to be missed and misdiagnosed. Medical staff should strengthen the awareness of this disease to make timely diagnosis and treatment.