一名出现呼吸急促、发烧和嗜酸性粒细胞增多症的患者。

S. Varghese, M. Kouma, D. Storey, R. Arasaratnam
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引用次数: 0

摘要

一名70岁的退伍军人,有2型糖尿病病史,并发周围神经病变和双侧足部溃疡,既往患有肺结核(2013年6月接受治疗),因双侧足部疼痛、肿胀和原有溃疡引流恶化而被送往外部医疗机构。他被诊断为双侧第五趾骨髓炎,出院后静脉注射达托霉素600 mg(8 mg/kg)和厄他培南1 g/d,疗程6周。出院时,患者情况稳定。我们的门诊肠外抗菌治疗(OPAT)团队进行了随访,该团队由一名传染病药剂师和抗菌管理主任医师组成,他们负责监测接受门诊静脉抗生素治疗的退伍军人。1三周后,作为常规OPAT监测的一部分,患者通过电话报告他的足部骨髓炎稳定,但他发烧101华氏度,并再次咳嗽。他接到指示立即去急诊室。抵达时,全血细胞计数(CBC)显示白细胞增多,嗜酸性粒细胞升高至2.67 K/μL,而一周前为0.86 K/μL(参考范围,0至0.5 K/μ)(eAppendix,可在doi:10.2788/fp.0336上获得)。肾和肝功能在正常范围内。新冠肺炎检测呈阴性。最初的检查是显著的轻度呼吸窘迫,房间空气中的氧饱和度为90%,呼吸频率为25次呼吸/分钟。肺部检查显示双侧有裂纹。他报告没有皮疹或粘膜损伤。通过鼻插管将患者置于2L/min的氧气中。胸部X线片显示右侧不透明;然而,进一步的计算机断层扫描(CT)胸部成像对双侧混浊具有重要意义(图1)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Patient Presenting With Shortness of Breath, Fever, and Eosinophilia.
A 70-year-old veteran with a history notable for type 2 diabetes mellitus, complicated by peripheral neuropathy and bilateral foot ulceration, and previous pulmonary tuberculosis (treated in June 2013) presented to an outside medical facility with bilateral worsening foot pain, swelling, and drainage of preexisting ulcers. He received a diagnosis of bilateral fifth toe osteomyelitis and was discharged with a 6-week course of IV daptomycin 600 mg (8 mg/kg) and ertapenem 1 g/d. At discharge, the patient was in stable condition. Follow-up was done by our outpatient parenteral antimicrobial therapy (OPAT) team, which consists of an infectious disease pharmacist and the physician director of antimicrobial stewardship who monitor veterans receiving outpatient IV antibiotic therapy.1 Three weeks later as part of the regular OPAT surveillance, the patient reported via telephone that his foot osteomyelitis was stable, but he had a 101 °F fever and a new cough. He was instructed to come to the emergency department (ED) immediately. On arrival, complete blood count (CBC) revealed leukocytosis with elevated eosinophils to 2.67 K/μL compared with 0.86 K/μL (reference range, 0 to 0.5 K/μL) 1 week earlier (eAppendix, available at doi:10.2788 /fp.0336). Renal and liver function were within normal limits. A COVID-19 test was negative. The initial examination was notable for mild respiratory distress with oxygen saturation of 90% on room air and a respiratory rate of 25 breaths/min. A lung examination showed bilateral crackles. He reported no skin rash or mucosal lesions. The patient was placed on 2 L/min of oxygen via nasal cannula. A chest radiograph showed rightsided opacities; however, further computed tomography (CT) chest imaging was significant for bilateral opacities (Figure 1).
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