溃疡性结肠炎合并李斯特菌脑膜炎1例  

Ulcerative colitis complicated with Listeria meningitis:A case report

作　　者：任璐[1,2] 刘娜 刘广阔[2] 张晓伟 Lu Ren;Na Liu;Guang-Kuo Liu;Xiao-Wei Zhang(Graduate School,Hebei Medical University,Shijiazhuang 050017,Hebei Province,China;Department of Gastroente-rology,Hebei General Hospital,Shijiazhuang 050017,Hebei Province,China;Department of Nutrition,Hebei General Hospital,Shijiazhuang 050017,Hebei Province,China)

机构地区：[1]河北医科大学研究生院,河北省石家庄市050017 [2]河北省人民医院消化内科,河北省石家庄市050051 [3]河北省人民医院营养科,河北省石家庄市050051

出　　处：《世界华人消化杂志》2023年第19期830-836,共7页World Chinese Journal of Digestology

摘　　要：背景糖皮质激素在治疗重度溃疡性结肠炎时可抑制细胞免疫功能从而引发单核细胞增生李斯特菌机会性感染.溃疡性结肠炎合并李斯特菌脑膜炎在临床上少见,易造成误诊.病例简介患者第一次主因“腹泻、粘液脓血便1个月,间断发热20余天”入我院治疗,确诊为溃疡性结肠炎,给予糖皮质激素后病情逐渐缓解,在院外口服激素过程中,进食可疑污染食物,造成病情反复,并合并李斯特菌脑膜炎,给予氨苄西林抗感染及脑室钻孔引流术后,患者病情仍危重,家属因经济原因签字离院,后随访患者死亡.结论糖皮质激素被广泛用于重度溃疡性结肠炎的治疗,同时也易造成细胞免疫抑制,是引起机会性感染的高危因素之一.而单核细胞增生李斯特菌通常在人类肠道中处于携带状态,免疫功能低下可促进其通过受损的肠道黏膜入侵机体,造成各个系统的感染,由于李斯特菌主要侵袭中枢神经系统,在应用大剂量糖皮质激素治疗溃疡性结肠炎过程中,需要警惕李斯特菌感染,及时发现头痛,意识改变和脑膜炎体征,完善血培养和脑脊液培养后尽早使用能通过血脑屏障,对李斯特菌敏感的抗生素,以降低死亡率.BACKGROUND Listeria monocytogenes,as an intracellular Gram-positive rod bacterium,is usually transmitted by contaminated food,which mainly affects the central nervous system in immunocompromised patients.Listeria monocytogenes infection in a setting of an ulcerative colitis(UC)flare is clinically rare.CASE SUMMARY We report a 55-year-old man with UC flare-up complicated with Listeria meningitis.It was immunosuppression caused by high-dose steroid therapy that induced his infection.CONCLUSION Clinicians must remain vigilant with invasive Listeria infection in patients diagnosed with ulcerative colitis receiving high-dose steroid.Early recognition and prescription of specific antibiotics can decrease the risk of exacerbation.

关 键 词：结肠炎 溃疡性 单核细胞增生李斯特菌 脑膜炎 糖皮质激素 

分 类 号：R574.62[医药卫生—消化系统]