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| 传染性单核细胞增多症合并手足口病1例 |
| A case of infectious mononucleosis with hand, foot and mouth disease |
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| DOI：10.3969/j.issn.1007-8134.2023.04.19 |
| 中文关键词: 传染性单核细胞增多症 手足口病 儿童 发热 皮疹 白细胞 淋巴细胞 |
| 英文关键词: infectious mononucleosis hand, foot and mouth disease children fever rash white blood cells lymphocytes |
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| 中文摘要: |
| [摘要]?儿童传染性单核细胞增多症（infectious mononucleosis, IM）合并手足口病（hand, foot and mouth disease, HFMD）病例较少见。本文报道1例儿童IM合并HFMD病例。患儿男，年龄为3岁8个月，因发热、皮疹入院。病原学检查结果：EB病毒（Epstein-Barr virus, EBV）早期抗原IgG 阳性，EBV VCA抗体IgM 阳性，EBV VCA抗体IgG 阳性，EBV核心抗原IgG 阴性。血清EBV DNA检测结果：1.31×105/ml。咽拭子HFMD病原体核酸检测结果：肠道病毒通用型定性检测阳性。血常规结果：白细胞计数20.47×109/L，淋巴细胞总数 18.03×109/L，淋巴细胞比例 88.1%，外周血细胞形态检测显示异性淋巴细胞约占20%。血ALT 248 U/L。肌酸激酶同工酶-MB 50 U/L，乳酸脱氢酶 576 U/L，AST 128U/L。乳酸脱氢酶同工酶-1 105 U/L。诊断为 IM；HFMD；肝功能受损，心肌损害。患儿入院后予以头孢美唑抗感染、更昔洛韦抗病毒，同时给予护肝、营养心肌等对症支持治疗，住院治疗5 d，病情较前明显好转出院。出院后继续巩固治疗，出院1周后复查各项指标逐渐回复正常，出院3周后复查各项指标恢复正常，但是EBV DNA定量为 5.98×104拷贝/ml。该个案提示：对于临床上确诊为HFMD的患儿，如果血常规显示白细胞计数较高，分类里以淋巴细胞比例高为主，需警惕合并IM；另外如果患儿反复发热时间长，也需要警惕合并IM的可能。 |
| 英文摘要: |
| [Abstract] Children with infectious mononucleosis (IM) and hand, foot and mouth disease (HFMD) are rare. This article reports a case of IM combined with HFMD in a child. The male patient, aged 3 years and 8 months, was admitted due to fever and rash. Etiological examination results: Epstein-Barr virus (EBV) early antigen IgG positive, EBV VCA antibody IgM positive, EBV VCA antibody IgG positive, and EBV core antigen IgG negative. Serum EBV DNA test result: 1.31×105/ml. Nucleic acid test result of HFMD pathogen in throat swab: Enterovirus universal qualitative test is positive. Routine blood test results: White blood cell count 20.47×109/L, total lymphocyte count 18.03×109/L, the proportion of lymphocytes is 88.1%, and the morphology of peripheral blood cells shows that heterologous lymphocytes account for about 20%. Blood ALT 248 U/L. Creatine kinase Isozyme MB 50 U/L, lactate dehydrogenase 576 U/L, AST 128 U/L. Lactate dehydrogenase Isozyme -1 105 U/L. Diagnosed as IM; HFMD, impaired liver function and myocardial damage. After admission, the children were given cefmetazole anti infection, Ganciclovir anti-virus, and symptomatic support treatment such as liver protection and myocardial nutrition. After 5 d of hospitalization, the condition was significantly improved and discharged. Continue to consolidate treatment after discharge. After 1 week of discharge, all indicators gradually return to normal. After 3 weeks of discharge, all indicators return to normal, but the EBV DNA quantification is 5.98×104 copies/ml. This case suggests that for children diagnosed with HFMD in clinical practice, if the blood routine shows a high white blood cell count and the classification is mainly based on a high proportion of lymphocytes, it is necessary to be vigilant for the combination of IM; In addition, if the child has recurrent fever for a long time, it is also necessary to be vigilant about the possibility of merging with IM. |
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