Orientia Tsutsugamushi-Induced Leukocytoclastic Vasculitis-A Case Report

恙蟲病所引起之白血球破碎性血管炎－病例報告

曾世嗚(Shih-Ming Tseng) ； 蕭玉屏(Yu-Ping Hsiao) ； 施宏俊(Hung-Jin Shih) ； 許永祥(Yung-Hsiang Hsu) ； 楊仁宏(Jen-Hung Yang)

《中華皮膚科醫學雜誌》 25卷2期 (2007/06) Pp. 142-146

https://doi.org/10.29784/DS.200706.0011

摘要

恙蟲病是一種由恙蟲所傳播人畜共通傳染病，為地方性傳染病，多發生在東亞國家和澳洲。恙蟲病通常以不明原因的發燒和其他不明確的全身性症狀來表現。我們報告一個由恙蟲病所引起的白血球破碎性血管炎病例，臨床上病人以不明原因的發燒和關節痛來表現，Weil-Felix檢查與間接免疫螢光抗體試驗都呈陽性反應，在皮膚病灶方面，主要在雙腿看到一些凸起且疼痛的紫斑和壞疽性丘疹，皮膚病理切片顯示典型的白血球破碎性血管炎，且immunperoxidase檢查可見血管壁有對抗56 kD之立克次體病原菌的抗原抗體反應，我們以doxycycline治療病人，在兩週內皮膚病灶完全消失。就吾人所知，這是台灣首例證實為恙蟲病所引起的白血球破碎性血管炎之病例報告。

並列摘要

Scrub typhus (also named Tsutsugamushi disease), a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic infectious disease in east Asia and Australia. This disease usually presents as an acute febrile illness with non-specific symptoms. We reported a case of the scrub typhus with leukocytoclastic vasculitis who suffered from acute pyrexia of unknown origin and arthralgia. Weil-Felix test and indirect immunofluorescent antibody technique revealed positive findings. The skin revealed multiple palpable painful purpura on bilateral lower limbs. Histopathology revealed leukocytoclastic vasculitis, and immunoperoxidase study disclosed positive staining of the antibody against 56 kD Rickettsial antigen in involved vascular endothelial cells and perivascular stroma. The patient was treated with doxycycline, and the skin lesions subsided in two weeks. To the best of our knowledge, this is the first proven case of leukocytoclastic vasculitis induced by Orientia tsutsugamushi in Taiwan.

並列關鍵字

Scrub typhus ； Tsutsugamushi disease ； leukocytoclastic vasculitis ； Doxycycline