关键词: 结核,肺, 危重病人医疗, 呼吸功能不全, 细小病毒B19,人, 血小板减少

Abstract:

The clinical diagnosis and treatment process of a case of 20-year-old female admitted to the tuberculosis ICU department of Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine on January 16,2021 were analyzed. The patient with tuberculous damaged lung complicated with parvovirus B19 infection and severe thrombocytopenia caused by suspected hemophagocytic syndrome. The patient was admitted to the hospital with chief complaint of cough with weight loss for 3 months, black stool for 15 days, aggravation with epistaxis for 2 days. Based on laboratory test, imaging,bone marrow biopsy and metagenomic detection of pathogenic microorganisms of bone marrow fluid, the patient was diagnosed as severe anemia, left tuberculous damaged lung, respiratory failure, cellular immune dysfunction, severe thrombocytopenia with unknown cause, parvovirus B19 infection and suspected hemophagocytic syndrome (suspected after death). After anti-tuberculosis, anti-infection, infusion of erythrocyte suspension, platelet, plasma and immunoglobulin pulse therapy, the condition was not improved. On the 5th day of admission, the condition was relieved after the application of extracorporeal membrane oxygenation due to aggravation of respiratory failure. However, respiratory failure aggravated due to pneumothorax in the right lung on the next day. In the condition of persistent thrombocytopenia and failure to improve coagulation function,the patient eventually died of respiratory failure and massive hemorrhage of airway and digestive tract. We believe that when tuberculous damaged lung is complicated with obvious thrombocytopenia, the cause of thrombocytopenia should be actively find; when combined with inhibition of cellular immune function, it shoule be considered whether opportunistic infection is complicated; when with the cause of thrombocytopenia is unknown and difficult to correct, and complicated with opportunistic infection, the occurrence of hemophagocytic syndrome should be highly vigilant.

Key words: Tuberculosis,pulmonary, Critical care, Respiratory insufficiency, Parvovirus B19,human, Thrombocytopenia