Leptospirosis presenting as haemorrhagic fever in visitor to Africa
Leptospirosis presenting as haemorrhagic fever in visitor to Africa
复制标题
非洲游客感染钩端螺旋体病并表现为出血热
DOI：
10.1016/s0140-6736(05)64865-9
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
D. Postic
中科院分区：
文献类型：
--
作者：
J. Monsuez;R. Kidouche;Bernard Le Gueno;D. Postic
Systemic sclerosis (scleroderma) is an autoimmune connective tissue disease with an often progressive and fatal course involving skin and vital organs. There is no definitive treatment. The pathology is complex, but a substantial immunological component is implied by the consistent finding of T-cells of the α/β subset producing interleukin-2 in biopsy specimens of involved organs. 1 In addition, some success has been noted following immunosuppression of the lung involvement with cyclophosphamide. 2 We report a case treated with immune ablation followed by autologous haemopoietic stem cell transplantation (HSCT) with apparent early (followup 6 months) response.A 37-year-old woman developed Raynaud’s phenomenon in the hands 5 years ago. 2 years later, during the third trimester of her only pregnancy, she developed skin thickening and joint stiffness which rapidly progressed after parturition such that 6 months later she had diffuse skin involvement with pigmentation changes (skin score 41), myositis, and high resolution computed tomographic evidence of fibrosing alveolitis (plain radiographs normal). Lung function tests showed mild restriction (probably external) but normal diffusion capacity (TLCO). No doppler-echo evidence of pulmonary hypertension was found, and systemic blood pressure remained normal. Antinuclear antibody was positive (titre 5120) with a fine, speckled, diffuse, and nucleolar pattern, and Scl 70 antibody was positive at a titre above 1000 by ELISA. Other laboratory values were normal, including serum creatinine and urinalysis. Despite initial symptomatic improvement on prednisone 25 mg, felodipine, and penicillamine, the skin involvement progressed and after 6 months penicillamine-induced glomerulonephritis developed (biopsy proven with no signs of systemic sclerosis renal changes). TLCO dropped to 18· 9 mL/min per mm Hg (67% normal).
