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貓抓病－病例報告及文獻回顧
Cat-scratch Disease-A Case Report and Review of Literatures
摘要
貓抓病是屬於良性的局部淋巴腺炎。大部份發生於小孩子和青年人。但是，因為大多會自行緩解而容易被病人及醫生所忽略。目前證實貓抓病的致病因是一種多形性的格蘭氏陰性桿菌。其特點在於初期接種菌處俱有典型的丘疹，以及局部淋巴腺腫。貓抓病的診斷有賴於臨床上高度的懷疑。在治療上，以症狀治療為主；抗生素的使用仍有賴進一步的研究。它雖然是自限性的疾病，但在免疫功能不全的患者卻會引起較嚴重的併發症，甚至死亡。我們報告了一例病例，具有被貓咬的病史，因為高燒不退且出現典型的貓抓病特徵而住院。病人在排除惡性腫瘤的可能性之後，接受口服四環黴素的治療。受侵犯的淋巴腺在住院第9天時呈化膿狀，且接受外科切開引流手術。病人的臨床症狀迅速改善且痊癒而出院。
並列摘要
Cat-scratch disease (CSD) is a type of benign, self-limited disease, typically affects children and young adults with characteristic of skin papule at the inoculation site and followed by regional lymphadenopathy. It was usually ignored by the patient himself, but also the doctor due to its tendency of spontaneous resolution. CSD is caused by a pleomorphic gram-negative rod. Although it is self-limited, but occassionally it may presented with systemic symptoms, even life-thereatening, especially in the immunocompromized host. Management is directed to alleviate symptoms, and the use of antibiotic should still be further comfirmed. We reported a 22-year-old man with 5 days history of tender mass over right axilla and high fever for 2 days. He had a positive history of cat bite over right index about one month ago. The other physical examinations and laboratory data all revealed unremarkable. Fine needle aspiration of the involved lymph node was performed on the 1st hospital day (H.D.) and yielded no pus formation and negative malignant change. He received oral tetracycline since the 2nd R.D. with good response. Suppuration of the lymph nodes developed on the 9th hospital day. The pathocytologic and bacteriologic examinations of the pus all yielded negative finding. We presented this case for emphasizing the importance of diagnosis of CSD with making high index of suspicion to the patient with regional lymphadenopathy associated with the history of cat contact.