【摘要】 目的 分析急性播散性脑脊髓炎的临床特点，提高诊疗。 方法 收集1999年1月-2010年1月住院的急性播散性脑脊髓炎患者42例，对其临床症状体征、实验室检查、影像学改变及治疗进行全面回顾性分析。 结果 42例患者中5～14岁者11例（26.19%）；15～40岁者20例（47.62%），感染后引起的23例（54.76%），无明显诱因占15例（35.71%）；脑脊液23例（23/34，67.65%）异常；脑电图异常者27例（27/32，84.38%）；CT检查阳性率26例（26/40，65.00%），MRI阳性率25例（25/28，89.29%）；糖皮质素、丙种球蛋白治疗有效。 结论 急性播散性脑脊髓炎是一组临床表现多样的免疫介导的炎性疾病，脑脊液、MRI和脑电图有重要诊断价值。急性期大剂量皮质素、静脉丙种球蛋白治疗均有较好疗效。【Abstract】 Objective To analysis the clinical features of acute disseminated encephalomyelitis so as to improve medical treatment. Methods From January, 1999 to January, 2010, 42 inpatients with acute disseminated encephalomyelitis were collected and their clinical data were analyzed retrospectively. Results Out of these 42 patients, 11 (26.19% ) were within 5 to 14 years, 20 (47.62%) ithin 15 to 40 years; 23 (54.76%) had definite infection, and 15 (35. 71%)had no any causes; 23 (23/34, 67.65%) had abnormal cerebrospinal fluid; 27 (27/32, 84.38%) had abnormal electro-encephalograph; 26 (26/40, 65.00%) were CT positive, 25 (25/28, 89.29%) MRI positive; corticosteroids and gamma globulin were effective in the treatment of disseminated encephalomyelitis. Conclusion Acute disseminated encephalomyelitis is a kind of inflammatory disease with various clinical manifestation and mediated by immune. Cerebrospinal fluid, MRI, and electro-encephalograph have important roles in its diagnosis. Large dose of corticosteroids and gamma globulin are effective in the treatment of acute disseminated encephalomyelitis.
Objective To summarize the characteristics of disseminated Penicillium marneffei infection.Methods The clinical, imageological and bacteriological characteristics were summarized by reviewing one case of disseminated Penicillium marneffei infection in an immunocompetent patient diagnosed in our hospital and the related literatures. Results The patient was a 32-year-old Guangdong male, whose main clinical features were fever, cough, and the abscess of pulmonary, tracheomucosa and subcutaneous. Routine blood examination showed leukocytosis. Other laboratory examination revealed multiple lesions of heart, liver, and kidney. Multiple masses histopathology revealed inflammation, but the culture from the purulent exudates were negative and standard antibiotic therapy was useless. Bronchoscope revealed gray nodus on airway mucosa. Under the direction of bacteriologist, final diagnosis of Penicillium marneffei infection was obtained by the fungal culture from the purulent exudates and the deep sputum. Conclusions Penicillium marneffei can infect immunocompetent patients. Disseminated Penicillium marneffei infection should be considered when patients presented with multiple organ lesions and multiple subcutaneous pyogenic masses which can not explained by connective tissue disease or common pyogenic infection, and with epidemiology of southeast life history.