表现为泛发性皮疹的地方性斑疹伤寒1例  

Endemic Typhus with Generalized Rash:A Case Report

作　　者：龙博泉 龙绮 赖美妍 杨岚 游馥榕 杨亚军 郭红卫 LONG Boquan;LONG Qi;LAI Meiyan;YANG Lan;YOU Furong;YANG Yajun;GUO Hongwei(Department of Dermatology,The Second Afiliated Hospital of Guangdong Medical University,Zhanjiang 524003,China;Guangdong Medical University,Zhanjiang 524003,China)

机构地区：[1]广东医科大学附属第二医院皮肤科,广东湛江524003 [2]广东医科大学,广东湛江524003

出　　处：《皮肤科学通报》2024年第2期195-199,共5页Dermatology Bulletin

摘　　要：患者男,26岁,双下肢肌痛、头痛伴发热5 d,斑疹2 d。5 d前水库活动疑有虫咬史。体查:体温38.2℃~38.5℃,生命征平稳。双下肢、胸腹部及上肢可见多发淡红色、暗红色斑疹、斑片及斑丘疹,豆大至指头大,环状及不规则状,边界清,压之不褪色,无焦痂。双侧踝关节、腓肠肌轻度压痛。实验室检查:外斐氏反应OX19 1∶160,肝功能轻度损害。诊断:地方性斑疹伤寒。予抗立克次体治疗:口服多西环素(0.2 g/d)联合左氧氟沙星片(0.5 g/d),给药当天起无发热,共用药8 d,患者皮疹基本消退,无关节疼痛、头痛,治愈出院。A 26-year-old male patient presented with myalgia,headache and fever in both lower limbs for 5 days and macula for 2 days.He was suspected insect bites from reservoir activities 5 days ago.Physical examination showed T:38.2℃-38.5℃,vital signs stable.Multiple light red and dark red macules,patches and maculopapular rashes presented on the lower limbs,chest,abdomen and upper limbs,bean to finger size,circular and irregular shape,clear border,fast color,no escharb.He felt mild tenderness of bilateral ankle joint and gastrocnemius muscle.Laboratory examination:Weifer′s reaction OX191∶160,mild liver function impairment.Diagnosis:endemic typhus.Anti-rickettsial treatment:oral doxycycline(0.2 g/d)combined with levofloxacin tablets(0.5 g/d),no fever from the day of administration.Eight days later,the patient′s rash basically subsided,no joint pain and headache.

关 键 词：地方性斑疹伤寒 鼠蚤 皮疹 抗立克次体治疗 

分 类 号：R751[医药卫生—皮肤病学与性病学] R513.1[医药卫生—临床医学]