Intravenous Immunoglobulin Therapy in a Patient with Tuberculosis-associated Hemophagocytic Syndrome: A Case Report

一位瀰漫性結核併嗜血症候群及多重器官衰竭病患接受靜脈注射免疫球蛋白治療的經驗

吳福平(Fu-Ping Wu) ； 蘇文麟(Wen-Lin Su) ； 彭萬誠(Wann-Cherng Perng) ； 陳健文(Chien-Wen Chen)

《胸腔醫學》 24卷1期 (2009/02) Pp. 20-26

https://doi.org/10.29806/TM.200902.0003

摘要

嗜血症候群是一種罕見但可能致命的疾病。臨床上以不明熱，肝脾腫大，血球低下等方式表現。其病因與感染，遺傳，腫瘤，和自體免疫有關。嚴重嗜血症候群患者也會出現休克，急性呼吸窘迫症候群，以及多重器官衰竭等情形。
本文描述一位重症患者於臨床上診斷出嗜血症候群後，連續接受靜脈注射免疫球蛋白治療兩日而成功改善其血流動脈學與呼吸狀態。後經系列檢查後發現痰液及血液之結核菌聚合酶連鎖反應(polymerase chain reaction)為陽性，痰液之結核菌培養亦為陽性。病患在接受抗結核藥物治療三週後成功拔除氣管內管。結核感染於結核病盛行區應列入嗜血症候群的鑑別診斷，短期使用靜脈注射免疫球蛋白有助穩定此類重症病患之病況。

關鍵字

嗜血症候群 ； 靜脈注射免疫球蛋白治療 ； 結核

並列摘要

Hemophagocytic syndrome is an uncommon but severe fatal condition associated with a variety of infectious agents, as well as genetic, neoplastic, and autoimmune diseases. We report a 63-year-old man presenting with severe shock, acute respiratory distress syndrome, and multi-organ failure. Hemophagocytic syndrome was suspected due to the high level of serum ferritin and cytopenia, and was confirmed by bone marrow aspiration. His hemodynamic status, cytopenia, and oxygenation improved dramatically after administration of intravenous immunoglobulin for 2 consecutive days. Tuberculosis was confirmed by positive polymerase chain reaction for tuberculosis in the sputum and blood, and later by sputum mycobacterium culture. He recovered uneventfully and was successfully weaned from the ventilator. This case highlights disseminated tuberculosis as a potential cause of HPS; immediate intravenous immunoglobulin administration may rescue the patient from the catastrophic state.

並列關鍵字

hemophagocytic syndrome ； intravenous immunoglobulin ； tuberculosis