- 期刊
Kawasaki Disease with Reye Syndrome: Report of One Case
川崎病合併雷氏症候群：一病例報告
摘要
本文報告一例七個月大之女孩，因五天以上的發燒而於本院住院，理學檢查發現(1)兩側性結膜炎(2)草莓樣舌(3)手掌，腳掌浮腫，指頭並有脫屑變化(4)卡介苗接種處有紅腫變化。經診斷爲川崎病，即給予高劑量aspirin (100 mg/kg/day)和免疫球蛋白(IVIG) 400 mg/kg/day治療四天，給予免疫球蛋白後第二天即退燒並於住院六天後出院，出院後當天病童又多次嘔吐和意識較爲嗜睡而再至本院求診，住院後實驗室檢查發現AST，ALT，NH3有明顯之升高，血糖下降，PT.PTT.延長並合併有代謝性酸中毒，肝臓切片病理報告發現肝臓有廣泛之脂肪變性。病童不幸於住院第二天不治死亡。本文回顧過去十年的文獻報告，並未發現川病合併有雷氏症候群的病例。我們提出此病例報告並提醒在使用aspirin治療川崎病的同時，仍要注意其併發雷氏症候群的可能性。
關鍵字
無資料並列摘要
A seven-month-old girl was admitted to the Pediatrics Department of Mackay Memorial Hospital with the following symptoms and signs: (1) high fever for more than five days; (2) injection of bilateral conjunctiva; (3) bright red lips with strawberry tongue; (4) edematous change of palms and soles, followed by digit desquamation; (5) an ill-defined, erythematous plaque on the scar of the BCG. Kawasaki disease was diagnosed, and high dose aspirin (100 mg/kg/day) and intravenous gamma-globulin (IVIG) (400 mg/kg/day) were given for four days. The patient was afebrile on the second day after IVIG infusion, and was discharged six days after admission. A small single daily dose of aspirin (10 mg/kg/day) was given after the afebrile days. Unfortunately, vomiting and consciousness disturbance were noted one day after discharge. Laboratory data showed elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) and ammonia. Hypoglycemia and prolonged PT and PTT were also noted. Reye syndrome was suspected, and the patient was admitted to the intensive care unit for further management. A liver biopsy gave findings consistent with Reye syndrome. In spite of intensive treatment, the infant expired on the second day after admission. In a review of the literature, no correlation between these two syndromes was found. This rare case is presented to warn that Reye syndrome may follow Kawasaki disease when aspirin has been prescribed at a high dose.