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題名 | 散佈性淋病雙球菌感染症--病例報告並著重於皮膚表徵機轉之探討=Disseminated Gonococcal Infection--A Case Report with Emphasis on the Pathogenesis of Skin Manifestation |
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作者 | 游鴻儒; 盧金坊; 史濟青; | 書刊名 | 中華皮膚科醫學雜誌 |
卷期 | 15:2 1997.06[民86.06] |
頁次 | 頁109-114 |
分類號 | 415.725 |
關鍵詞 | 散佈性淋病雙球菌感染症; 皮膚表徵機轉; Disseminated gonococcal infection; Pathogenesis; Skin manifestation; Circulating immune complex; Penicillin-resistant; |
語文 | 中文(Chinese) |
中文摘要 | 在台灣,散佈性淋病雙球菌感染症是一種非常少見的疾病。吾人報告一台籍43歲女性,主訴發燒及多關節疼痛,兩天後出現紅色丘疹及膿泡疹。皮膚病理顯示表皮內膿腫,血管炎並有微小栓塞形成,在格蘭氏染色下並可發現許多陰性雙球菌. 陰道分泌物枺片可見格蘭氏陰性雙球菌,並於巧克立培養基中培養出淋病雙球菌;而血液培養並未發現任何細菌. 病患住院後接受靜脈注射青黴素七日,病況無明顯改善。其細菌培養及抗生素敏感報告顯示對青黴素及美滿黴素有抗藥性,但對紅黴素敏感. 病患接受口服紅黴素(每日兩公克)治療,關節疼痛於兩日後有明顯改善,而皮疹於五日內消失。吾人報告此一典型散佈性淋病雙球菌感染症病例,並提出散佈性淋病雙球菌感染皮膚表徵之可能致病機轉。 |
英文摘要 | Disseminated gonococcal infection (DGI) is a very rare disease in Taiwan. We report a 43-year-old femal patient who initially presented with fever and multiple joint pain. Two days later, multiple discrete papules, pustules with erythematous base were found. Skin biopsy revealed acute suppurative inflammation with subcorneal abscess formation, septic vasculitis with microthrombus formation. Gram negative diplococci were demonstrated by Gram stain. Culture was performed from vaginal discharge revealed Neisseria gonorrhoeae which was resistant to penicillin and minocycline, but sensitive to erythromycin. Gram negative diplococci were also found in the direct smear from vaginal discharge. The blood culture yielded no growth. The patient received intravenous injection of aqueous penicillin for 7 days without clinical improvement. Therapy was shifted to erythromycin (2gm/day) orally for 10 days according to the bacterial sensitivity test. The arthralgia improved dramatically within 2 days, and the skin eruptions cleared within 5 days after erythromycin therapy. We herein report the typical DGI case, and propose the pathogenesis of skin manifestation in disseminated gonococcal infection. |
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