Reactive Hemophagocytic Syndrome in Patient with Acute Hepatitis B: Report of a Case

反應性血球吞噬症候群為罕見且高致死率(30~100%)的疾病，早期症狀類似急性肝炎，故易被誤診而延誤治療時機。造成反應性血球吞噬症候群之常見致病因為感染、淋巴瘤、自體免疫疾病及藥物。本文報告－20歲男性因嘔吐、黃疸、持續高燒、茶色尿、頭痛及肝功能指數異常而住院。血液B型肝炎標記檢查發現罹患急性B型肝炎，其他肝炎標記及病毒血清學檢查皆為陰性。腹部電腦斷層攝影檢查發現包括肝脾腫大、主動脈旁淋巴結腫大、及輕度腹水。經肝臟切片及骨髓抹片檢查證實為急性B型肝炎併發反應性血球吞噬症候群，病人接受靜脈注射類固醇及咖瑪球蛋白治療後，病況改善而辦理出院。國內曾有A型合併C型肝炎併發反應性血球吞噬症候群之病例報告，經治療後，病例仍死亡。故提出此一治療成功病例以供臨床醫師處置類似案例之參考。

關鍵字

急性B型肝炎；血球吞噬症候群；咖瑪球蛋白

並列摘要

Reactive hemophagocytic syndrome is a high mortality rate disorder. This syndrome may mimic acute hepatitis in the early stages and is easily misdiagnosed; consequently, it has poor prognosis for delayed treatment. The common pathogenesis of reactive hemophagocytic syndrome are infection, lymphoma, autoimmune disease and drugs. We report a 20-year-old male who suffered from nausea, vomiting, tea-color urine, jaundice, high fever, headache and abnormal liver function. The laboratory data confirmed the impression of acute hepatitis B. Bone marrow aspiration and liver biopsy showed hemophagocytosis. Intravenous Dexamethasone and r-globulin were prescribed. After two months. treatment, he was discharged in stable condition. Acute hepatitis A with coexistent hepatitis C virus infection associated with hemophagocytic syndrome had been reported in our country, but the case died after treatment. Therefore, we present this successfully treated case as an example for physicians in managing those cases with the same disorder.

並列關鍵字

Acute hepatitis B ； hemophagocytic syndrome ； Υ-globulin

國際替代計量

Reactive Hemophagocytic Syndrome in Patient with Acute Hepatitis B: Report of a Case

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