The response of mpox-associated inflammatory syndrome to steroid therapy.
The response of mpox-associated inflammatory syndrome to steroid therapy.
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MPOX 相关炎症综合征对类固醇治疗的反应。
DOI：
10.1016/s1473-3099(22)00876-3
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Armstrong,Andrea
中科院分区：
文献类型：
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作者：
Arias,CesarA;Miller,WilliamR;Olsen,Randall;Gollihar,Jimmy;Armstrong,Andrea
一名47岁男子在与一名男子发生无保护性行为15天后出现轻度发热、寒战、肛门不适和双侧腹股沟淋巴结病，并被诊断为天花（以前称为猴痘）。性交后第17天，他的发热减轻，但肛门疼痛增加。体格检查发现约10个压痛肛周水疱性病变。第18天，他的肛门疼痛减轻，病变消退。第19天，在其大腿外侧发现疼痛性皮疹。第20天，患者因疼痛无法行走，并出现高烧（40· 3 ℃）。检查发现他的右大腿外侧有一个压痛性黄斑水肿性皮疹和非压痛性肛周红斑（图1）。实验室检查值显示白细胞增多、转氨酶升高和炎症标志物升高。HIV第4代检测、HIV病毒载量、血清水痘带状疱疹病毒PCR和快速血浆反应素试验均为阴性。血培养也呈阴性。万古霉素开始使用头孢吡肟（1.5 g，静脉注射，每12 h一次）、头孢吡肟（2 g，静脉注射，每8 h一次）、甲硝唑（500 mg，口服，每12 h一次）、多西环素（100 mg，口服，每12 h一次）和替考韦瑞（600 mg，口服，每日三次），但患者持续高热、腿部疼痛和炎症标志物增加（附录p 3）。重复的天花测试仍然是阳性。右大腿MRI显示广泛外侧皮下水肿。皮肤活检与海绵状皮炎一致，无病毒性细胞病变效应的证据，未鉴定出微生物，培养物为阴性。开始泼尼松减量疗程。患者明显改善，出院后接受类固醇减量治疗，阿莫西林（875 mg）+克拉维酸（125 mg）口服，每日两次，持续3天;左氧氟沙星（750 mg）口服，每日一次（持续3天;总抗生素治疗8天）;替考韦瑞仍为600 mg口服，每日三次（共14天）。门诊随访显示大腿和肛周皮疹明显改善（图）。临床表现提示mpox相关的炎症综合征，主要对类固醇有反应。
A 47-year-old man developed mild fevers, chills, anal discomfort, and bilateral groin lymphadenopathy 15 days after having unprotected sex with a man and was diagnosed with mpox (formerly known as monkeypox). On day 17 after sexual intercourse, his fever abated but anal pain increased. Physical exam revealed approximately 10 tender perianal vesicular lesions. On day 18, his anal pain decreased and lesions resolved. On day 19, a painful erythematous rash was noted in the lateral aspect of his thigh. On day 20, he was unable to walk due to pain and had high fever (40· 3 C). Examination revealed a tender macular erythematous rash on the lateral aspect of his right thigh and non-tender perianal erythema (figure 1). Laboratory values showed leukocytosis, transaminitis, and elevated inflammatory markers. An HIV 4th generation assay, HIV viral load, serum varicella zoster virus PCR, and rapid plasma reagin test were all negative. Blood cultures were also negative. Vancomycin (1· 5 grams intravenously, every 12 h), cefepime (2 grams intravenously, every 8 h), metronidazole (500 mg orally, every 12 h), doxycycline (100 mg orally, every 12 h), and tecovirimat (600 mg orally, three times a day) were initiated but the patient continued to have high fever, leg pain, and increased inflammatory markers (appendix p 3). A repeat mpox test was still positive. MRI of the right thigh showed extensive lateral subcutaneous oedema. A skin biopsy was consistent with spongiotic dermatitis without evidence of a viral cytopathic effect, no organisms were identified and cultures were negative. A tapering course of prednisone was started. The patient markedly improved and was discharged on a steroid taper, with amoxicillin (875 mg) plus clavulanate (125 mg) orally, twice daily for 3 days; levofloxacin (750 mg) orally, daily (for 3 days; total antibiotic therapy of 8 days); and tecovirimat still at 600 mg orally, three times a day (for a total of 14 days). An outpatient follow-up showed marked improvement in thigh and perianal rash (figure). The clinical presentation suggests an mpox-associated inflammatory syndrome that was mainly responsive to steroids.