Hoagland Sign as an Aid for Antimicrobial Stewardship—A Case Report

Q4 Medicine

Journal, Indian Academy of Clinical Medicine Pub Date : 2020-06-01 DOI:10.1177/26339447211068967

Lakshmi J. Nair, A. Reghukumar, Athul Gurudas, K. Sasidharan, K. Parvathy

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引用次数: 1

Abstract

Hoagland sign is an early and transient bilateral painless upper eyelid edema observed in patients with Epstein-Barr virus (EBV)-related infectious mononucleosis. This sign can predate the appearance of exudative pharyngitis and cervical lymphadenopathy. Usually, this sign disappears by first week of infection. Here, we describe the occurrence of late onset Hoagland sign in a 14-year old boy who presented to us on 10th day of fever. Hoagland sign appeared after 10 days from symptom onset in our patient. Despite persistence of fever, the presence of Hoagland sign which appeared prior to confirmation of EBV infection was a helpful indicator for stopping antibiotics. In view of tonsillar hypertrophy with potential airway compromise and biochemical parameters suggestive of possible secondary hemophagocytic lymphohistiocytosis, he was initiated on steroids with which defervescence and prompt resolution of symptoms occurred. EBV can present as acute undifferentiated febrile syndrome which might result in inappropriate use of antibiotics. This case highlights the importance of using clinical clues like Hoagland sign to optimize antimicrobial stewardship.

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霍格兰标志在抗菌药物管理中的辅助作用——一例报告

Hoagland征象是在eb病毒相关传染性单核细胞增多症患者中观察到的早期和短暂的双侧无痛性上眼睑水肿。该征象可早于渗出性咽炎和颈淋巴肿大的出现。通常，这种症状在感染的第一周就会消失。在这里，我们描述了一个14岁男孩的晚发性霍格兰征，他在发烧的第10天向我们提出。本例患者出现症状10天后出现霍格兰征。尽管持续发热，但在确认EBV感染之前出现的霍格兰体征是停止使用抗生素的有益指标。鉴于扁桃体肥大伴潜在气道损害和生化参数提示可能继发性噬血细胞淋巴组织细胞增多症，患者开始使用类固醇，并出现退热和症状迅速消退。EBV可表现为急性未分化发热综合征，这可能导致不适当使用抗生素。本病例强调了使用霍格兰标志等临床线索来优化抗菌药物管理的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal, Indian Academy of Clinical Medicine Medicine-Medicine (all)

CiteScore

0.10

自引率

0.00%

发文量

期刊介绍： Indian Association of Clinical Medicine is an academic body constituted in the year 1992 by a group of clinicians with the main aim of reaffirming the importance of clinical medicine in this era of high-tech diagnostic modalities. There is no doubt that modern investigational methods have contributed a lot to the present day medical practice but that does not render clinical acumen and examination less important. The art and science of clinical medicine helps up to make proper and judicious use of investigations and not these be the sole basis of our practice. That is the basic idea behind this ''Association''. We presently have members and fellows of the association from all over the country. In August, 2002 the body was registered as "Indian Association of Clinical Medicine" by the Registrar of Societies, Delhi.