热带肌炎:发热型 1 型糖尿病患者的非热带诊断。

Jack Bullis, Kenneth Fiala, Nicole Werner
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引用次数: 0

摘要

简介热带肌炎又称脓毒性肌炎,是一种亚急性骨骼肌原发性感染。长期以来,热带肌炎被认为是热带气候独有的一种诊断方法,但最近,这种疾病在历史上属于非热带气候的地区也有越来越多的报道。我们介绍了威斯康星州麦迪逊市的一例热带肌炎病例,该病例发生在一名发热的 1 型糖尿病患者身上,患者没有出过远门,也没有已知的接触史:一名 35 岁的男性患者,曾患冯-维勒布兰德病、1 型糖尿病,并因经济不安全而导致胰岛素配给不足,发病两周后全身乏力。经检查,他全身有许多大的红斑 "疙瘩",这些 "疙瘩 "在两周多的时间里不断增大。他的血糖为 518,白细胞增多,化验结果支持糖尿病酮症酸中毒。计算机断层扫描显示,左胸、双侧竖脊肌、右侧臀肌、双侧大腿、左腿、左上臂和左下臂出现广泛的肌肉内和皮下脓肿。患者开始接受广谱抗生素治疗和糖尿病酮症酸中毒治疗。血液和尿液培养结果显示金黄色葡萄球菌对奥沙西林敏感。临床症状稳定后,他接受了脓肿切开引流术。在住院一个多月后,他出院去了康复中心:讨论:严重的热带肌炎与高发病率和高医疗资源使用率有关。近年来,美国的病例呈指数级增长,有可能进一步加重本已不堪重负的医疗系统的压力。我们探讨了非热带地区热带肌炎病例增加的潜在原因,包括糖尿病和贫困率的上升以及气候变化。最近的数据表明,绝大多数热带肌炎病例是由产潘通-瓦伦丁白细胞介素毒素的金黄色葡萄球菌菌株引起的。如果患者及早接受蛋白合成抑制剂抗生素治疗,理论上可减轻疾病的严重程度,但这些研究结果仅限于病例报告和观察性研究,缺乏对照临床试验。本病例强调了对热带肌炎疑似病例进行早期识别、抗生素治疗和手术源控制的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tropical Myositis: A Not-So-Tropical Diagnosis in a Febrile Type 1 Diabetic Patient.

Introduction: Tropical myositis - also known as pyomyositis - is a subacute, primary infection of skeletal muscle. Long considered a diagnosis exclusive to tropical climates, recently it has been reported increasingly in historically nontropical climates. We present a case of tropical myositis in Madison, Wisconsin, occurring in a febrile type 1 diabetic patient without travel or known exposure.

Case presentation: A 35-year-old male with a history of von Willebrand disease, type 1 diabetes, and financial insecurity resulting in insulin rationing presented with 2 weeks of generalized weakness. On exam, he had a multitude of large, erythematous "bumps" across his body, which had been increasing in size for more than 2 weeks. His blood glucose was 518, with leukocytosis and labs supportive of diabetic ketoacidosis. Computed tomography revealed extensive intramuscular and subcutaneous abscesses of the left chest, bilateral erector spinae, right gluteal muscles, bilateral thighs, left leg, and left upper and lower arm. Broad-spectrum antibiotics were initiated, as was treatment for diabetic ketoacidosis. Blood and urine cultures revealed oxacillin-susceptible Staphylococcus aureus. After clinical stabilization, he underwent initial incision and drainage of the abscesses. His condition would require 14 more operative incision and drainage procedures and wound closure attempts before he was discharged to a rehab facility after more than a month-long hospitalization.

Discussion: Severe tropical myositis is associated with high morbidity and high use of health care resources. The exponential rise in cases in the United States in recent years risks further stressing an already-burdened health care system. We explore potential causes of the increase in cases of tropical myositis in nontropical regions, including increasing rates of diabetes and poverty and climate change. Recent data suggest that the large majority of tropical myositis cases are caused by Panton-Valentine leukocidin toxin-producing Staphylococcus aureus strains. There is a theoretical mitigation of disease severity when patients receive early protein synthesis inhibitor antibiotic treatment, though these findings are limited to case reports and observational studies and lack controlled clinical trials. This case highlights the need for early identification, antibiotic administration, and surgical source control in suspected cases of tropical myositis.

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