- 期刊
Fatal Hepatic Failure Associated with Varicellan in an Adult-Report of a Case
成人水痘併發致死性肝衰竭：一病例報告
摘要
吾人在此報告一例29歲女性水痘肝炎致死病例。她的兩個孩子，先後在她住院前兩星期罹患水痘，繼而她也續發腹痛、兩肋疫痛、發燒、厭食、噁心、嘔吐、呼吸不適及紫斑性皮膚發疹等臨床症狀。依據其接觸病史、典型皮疹、水痘血清檢測和細胞學抹片，而其他可能致死性病毒血清範檢皆呈陰性反應，確立診斷為水痘。病程中，她的皮疹數目持續增多，並且轉型成出血性水皰，同時併發上消化道大量出血、呼吸窘迫、肢端發紺、神智障礙、肝功能試驗呈現嚴重肝功能不全。吾人雖然馬上給予抗病毒藥物 。抗生素、利尿劑、降腦壓劑、新鮮冷凍血漿、又加上心肺功能支援性積極治療，但病人終因肝功能衰竭及凝血障礙等併發症而藥石罔效。據文獻報告，除非病人有免疫功能不全的情況，否則以往並無致死性水痘肝炎的病例報告。本病例報告冀望能提醒臨床醫師：發生於成人的水痘，足以引發致死性肝衰竭。
並列摘要
A 29-year-old woman had an acute onset of abdominal pain, bilateral flank soreness, fever, anorexia, nausea, vomiting, respiratory distress, and purpuric skin eruption. Her two children had had chickenpox two weeks prior to her admission. Varicella was diagnosed by the typical skin eruption, contact history, serologic test of varicella, as well as cytologic Tzanck smear. Screening tests for other viral infections were negative. Her skin rashes progressed with increasing number and hemorrhagic transformation of vesicles. Meanwhile, she developed massive upper gastrointestinal bleeding, respiratory distress, peripheral cyanosis, and conscious disturbance. Severe impairment of liver function tests were noted. Even though acyclovir, antibiotics, mannitol, fresh frozen plasma, and cardiopulmonary support were given immediately, the patient died of complications of hepatic failure and bleeding diathesis. To our knowledge, there is no report of fatal varicella hepatitis in the healthy adult except in immunocompromised hosts. This patient may have had such a rare condition and deserves attention.