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皮疹, 心力衰竭, 肾功能不全, 嗜酸性粒细胞增多:一例高龄衰弱老年患者

苏琳凡,  张宁,  王倩,  张路,  杨德彦,  夏鹏,  邵池,  朱鸣雷,  张莉,  康军仁,  孙晓红,  刘晓红,  李军,  李潇

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文章导航 > 协和医学杂志  > 2020 >  11(4): 479-485
苏琳凡, 张宁, 王倩, 张路, 杨德彦, 夏鹏, 邵池, 朱鸣雷, 张莉, 康军仁, 孙晓红, 刘晓红, 李军, 李潇. 皮疹, 心力衰竭, 肾功能不全, 嗜酸性粒细胞增多:一例高龄衰弱老年患者[J]. 协和医学杂志, 2020, 11(4): 479-485. doi: 10.3969/j.issn.1674-9081.2020.04.021
引用本文: 苏琳凡, 张宁, 王倩, 张路, 杨德彦, 夏鹏, 邵池, 朱鸣雷, 张莉, 康军仁, 孙晓红, 刘晓红, 李军, 李潇. 皮疹, 心力衰竭, 肾功能不全, 嗜酸性粒细胞增多:一例高龄衰弱老年患者[J]. 协和医学杂志, 2020, 11(4): 479-485. doi: 10.3969/j.issn.1674-9081.2020.04.021
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Lin-fan SU, Ning ZHANG, Qian WANG, Lu ZHANG, De-yan YANG, Peng XIA, Chi SHAO, Ming-lei ZHU, Li ZHANG, Jun-ren KANG, Xiao-hong SUN, Xiao-hong LIU, Jun LI, Xiao LI. Rash, Heart Failure, Renal Insufficiency, and Hypereosinophilia in an Elderly Frail Male[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(4): 479-485. doi: 10.3969/j.issn.1674-9081.2020.04.021
Citation: Lin-fan SU, Ning ZHANG, Qian WANG, Lu ZHANG, De-yan YANG, Peng XIA, Chi SHAO, Ming-lei ZHU, Li ZHANG, Jun-ren KANG, Xiao-hong SUN, Xiao-hong LIU, Jun LI, Xiao LI. Rash, Heart Failure, Renal Insufficiency, and Hypereosinophilia in an Elderly Frail Male[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(4): 479-485. doi: 10.3969/j.issn.1674-9081.2020.04.021
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皮疹, 心力衰竭, 肾功能不全, 嗜酸性粒细胞增多:一例高龄衰弱老年患者

doi: 10.3969/j.issn.1674-9081.2020.04.021
  • 1.

    中国医学科学院 北京协和医学院 北京协和医院内科学系, 北京 100730

  • 2.

    中国医学科学院 北京协和医学院 北京协和医院老年医学科, 北京 100730

  • 3.

    中国医学科学院 北京协和医学院 北京协和医院血液内科, 北京 100730

  • 4.

    中国医学科学院 北京协和医学院 北京协和医院心内科, 北京 100730

  • 5.

    中国医学科学院 北京协和医学院 北京协和医院肾内科, 北京 100730

  • 6.

    中国医学科学院 北京协和医学院 北京协和医院呼吸与危重症医学科, 北京 100730

  • 7.

    中国医学科学院 北京协和医学院 北京协和医院风湿免疫科, 北京 100730

  • 8.

    中国医学科学院 北京协和医学院 北京协和医院临床营养科, 北京 100730

  • 9.

    中国医学科学院 北京协和医学院 北京协和医院皮肤科, 北京 100730

  • 10.

    中国医学科学院 北京协和医学院 北京协和医院放射科, 北京 100730

详细信息
    通讯作者:

    张宁  电话:010-69154063, E-mail:253571870@qq.com

  • 中图分类号: R552

Rash, Heart Failure, Renal Insufficiency, and Hypereosinophilia in an Elderly Frail Male

  • 1.

    Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Geriatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 3.

    Department of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 4.

    Department of Cardiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 5.

    Department of Nephrology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 6.

    Department of Pulmonary and Critical Care Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 7.

    Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 8.

    Department of Clinical Nutrition, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 9.

    Department of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 10.

    Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information
    Corresponding author: ZHANG Ning  Tel: 86-10-69154063, E-mail:253571870@qq.com

    摘要
  • 摘要: 一例高龄老年患者, 多器官功能储备差, 嗜酸性粒细胞增多致心、肾慢性功能不全且急性加重, 经激素及免疫抑制剂治疗后嗜酸性粒细胞恢复正常、皮疹消退, 但后期出现卡氏肺孢子菌肺炎, 抗感染治疗疗效不理想, 最终患者因感染性休克死亡。本例患者基础情况复杂, 诊治过程一波三折, 经多学科团队共同参与讨论, 一步步解决患者诊疗决策中的难题, 体现了多学科协作在疑难病诊疗中的意义。临床上应认识到, 衰弱、谵妄亦是老年患者不良预后的危险因素, 老年人机体代偿能力弱, 不良反应耐受性差, 易出现不良结局。在临床诊疗工作中, 需权衡治疗并发症、远期收益、预期生存时间等多方面因素, 作出正确的治疗决策。
    Abstract: This patient was an elderly male with poor basal multi-organ function reserve, increased eosinophils leading to acute exacerbation of chronic heart and kidney dysfunction. After treatment with hormones and immunosuppressants, eosinophils were normal and the rash subsided. However, pneumocystis carinii pneumonia appeared in the later stage, and the anti-infective treatment was not ideal. Eventually the patient died of septic shock. In this case, the basic situation of the patient was complex, the diagnosis and treatment process was twists and turns, and the multidisciplinary team participated in and discussed to solve the problems in thediagnosis and treatment decision-making of the patient step by step, which embodied the significance of multidisciplinary cooperation in the diagnosis and treatment of difficult diseases.Based on the poor prognosis of the disease, it should be recognized clinically that weakness and delirium are also risk factors for poor prognosis in elderly patients. The elderly have weak compensatory ability, poor tolerance to adverse reactions, and are prone to adverse outcomes.In clinical diagnosis and treatment, the choice of plan needs to be considered in consideration of various factors such as treatment complications, long-term benefits, and expected survival time.
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  • 图  1  患者胸部CT示双肺病变(2019年4月29日)

    A.肺窗表现，可见多发肺大泡(箭头)；B.纵隔窗表现，可见胸腔积液(箭头)

    下载: 全尺寸图片 幻灯片

    图  2  患者胸部CT示双肺新发磨玻璃渗出影(黑色箭头)；双侧胸腔积液较前增多(白色箭头)(2019年5月20日)

    A、B.肺窗表现；C、D.纵隔窗表现

    下载: 全尺寸图片 幻灯片
    • 参考文献(10)
  • [1] 中华医学会血液学分会白血病淋巴瘤学组.嗜酸粒细胞增多症诊断与治疗中国专家共识(2017年版)[J].中华血液学杂志, 2017, 38:561-565. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhxyx201707001
    [2] Kurpas D, Gwyther H, Szwamel K, et al. Patient-centred access to health care:a framework analysis of the care interface for frail older adults[J]. BMC Geriatr, 2018, 18:273. doi:  10.1186/s12877-018-0960-7
    [3] 朱长真, 李康, 于健春, 等.再喂养综合征一例[J].协和医学杂志, 2015, 6:234-236. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xhyx201503019
    [4] Pardanani A, Lasho T, Wassie E, et al. Predictors of survival in WHO-defined hypereosinophilic syndrome and idiopathic hypereosinophilia and the role of next-generation sequencing[J]. Leukemia, 2016, 30:1924-1926. doi:  10.1038/leu.2016.73
    [5] Podjasek JC, Butterfield JH. Mortality in hypereosinophilic syndrome:19 years of experience at Mayo Clinic with a review of the literature[J]. Leuk Res, 2013, 37:392-395. doi:  10.1016/j.leukres.2012.12.016
    [6] Navarro I, Torras J, Gomà M, et al. Renal involvement as the first manifestation of hypereosinophilic syndrome:a case report[J]. NDT Plus, 2009, 2:379-381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421392/
    [7] Khalid F, Holguin F. Idiopathic Hypereosinophilic Syndrome in an Elderly Female:A Case Report[J]. Am J Case Rep, 2019, 20:381-384. doi:  10.12659/AJCR.912747
    [8] Rockwood K, Song X, Macknight C. A global clinical measure of fitness and frailty in elderly people[J]. CMAJ, 2005, 173:489-495. doi:  10.1503/cmaj.050051
    [9] Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice:developing the short-form mini-nutritional assessment (MNA-SF)[J]. J Gerontol A BiolSci Med Sci, 2001, 56:M366-372. doi:  10.1093/gerona/56.6.M366
    [10] Marcantonio ER. Delirium in Hospitalized Older Adults[J]. N Engl J Med, 2017, 377:1456-1466. doi:  10.1056/NEJMcp1605501
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  • 收稿日期:  2019-06-18
  • 刊出日期:  2020-07-30

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