尸检确诊的华佛综合征三例误诊原因分析  

Cause Analysis of 3 Misdiagnosed Cases of Autopsy-Proven Waterhouse-Friederichsen Syndrome

作　　者：穆娇[1] 屈希良 张吉[1] 邓姣娟 谢静茹[1] 徐层 曾飞[1] 董红梅[1] 

机构地区：[1]华中科技大学同济医学院法医系法医病理教研室,武汉430030 [2]宜昌市伍家公安分局刑警大队,湖北宜昌443003

出　　处：《临床误诊误治》2015年第5期71-73,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨华佛综合征的临床诊治要点,以避免误诊误治。方法对我院尸检法医鉴定的华佛综合征3例的临床及尸检资料进行回顾性分析。结果 2例以皮肤淤点或淤斑就诊,误诊为过敏性紫癜及过敏性休克;1例以咳嗽、喘息及呼吸困难为主要表现,误诊为呼吸系统感染。3例均发病急骤,病情危重,很快死亡,尸检并法医病理诊断为流行性脑膜炎并急性肾上腺功能衰竭(华佛综合征)2例,急性肾上腺功能衰竭(华佛综合征)1例。结论本病临床少见,病情进展快,易误诊。临床上一旦明确华佛综合征诊断,治疗应争分夺秒,若发现弥漫性血管内凝血应尽早使用肝素及抗纤维蛋白原溶解药物,积极抗休克治疗是关键。Objective To explore the key factors in diagnoses and treatment of Waterhouse-Friederichsen syndrome to avoid misdiagnosis and mistreatment. Methods The clinical and autopsy data of 3 cases of Waterhouse-Friederichsen syn-drome in the Department of Forensic Medicine, Tongji Medical College were reviewed. Results 2 cases presented with pete-chiasis or ecchymosis, and both were misdiagnosed as allergic purpura and anaphylactic shock. However, cough, asthma and dyspnea were complained as main clinical manifestations in 1 case, which was misdiagnosed as respiratory tract infection. All the patients with acute onset died soon. The forensic pathological diagnosis was acute adrenal function failure （ Waterhouse-Friederichsen syndrome） due to epidemic meningitis in 2 cases and acute adrenal function failure （ Waterhouse-Friederichsen syndrome） in 1 case. Conclusion This disease is rare, rapidly progressive and tends to be misdiagnosed. When diagnosis of Waterhouse-Friederichsen syndrome is definite, the patient should be treated as soon as possible. The effective strategy for treatment would be anti-coagulation with Heparin and anti-fibrinolytic drug and anti-shock remedy.

关 键 词：华佛综合征 肾功能不全 误诊 紫癜 过敏性 休克 呼吸道感染 

分 类 号：D919[医药卫生—法医学]