NDLI: Sepsis mit akralen Nekrosen bei einer Patientin mit Sharp-Syndrom

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Silbernagel, G. Schmalzing, M. Riessen, R. Koetter, I.
Description	Author Affiliation: Silbernagel G ( Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie, Medizinische Universitätsklinik, Eberhard-Karls-Universität, Tübingen. guenther.silbernagel@med.uni-tuebingen.de)
Abstract	HISTORY AND ADMISSION FINDINGS: We report on a patient with Sharp-Syndrome who was referred to our emergency department with sepsis. In addition, the patient showed acral necrosis, particularly of the distal phalanges of the hands and of the tip of the nose. INVESTIGATIONS: Laboratory analyses showed an elevation of the inflammatory parameters (C-reactive protein elevation, leukocytosis). Furthermore, procalcitonin and the D-dimers were increased, antithrombin III, however, was decreased. The thoracic/abdominal computed tomography (CT) showed bilateral inferior lobe pneumonia with concomitant pleural effusions. As a secondary diagnostic finding the thoracic/abdominal CT and the abdominal ultrasound showed a markedly reduced size of the spleen. Finally, bacteria (Streptococcus pneumoniae) were found in the blood of the patient. DIAGNOSIS, TREATMENT AND COURSE: We diagnosed pneumococcal sepsis with disseminated intravasal coagulation and acral necrosis caused by pneumonia. The immune status was impaired due to immunosuppressive therapy (prednisolon and azathioprin) and functional asplenism. The patient was stabilized with antibiotic treatment, hydration, and drotrecogin (protein C). Transiently catecholamin treatment and oxygen substitution were necessary. Alprostadil was used to treat acral circulatory disorder. CONCLUSIONS: This case report shows the importance of consequent screening for organ manifestations in autoimmune diseases. In particular, this case report highlights the relevance of prophylactic vaccination in patients with autoimmune diseases, primarily those with autosplenectomy. Furthermore, this article gives a short overview about the pathogenesis, the diagnostic criteria of the Sharp-syndrome. The frequencies of organ involvement and the treatment options are also discussed.
File Format	HTM / HTML
ISSN	00120472
Issue Number	36
Volume Number	135
e-ISSN	14394413
Journal	DMW - Deutsche Medizinische Wochenschrift
Language	German
Publisher	Thieme Medical Publishers
Publisher Date	2010-09-01
Publisher Place	Germany
Access Restriction	Subscribed
Subject Keyword	Discipline Medicine Fingers Pathology Mixed Connective Tissue Disease Complications Nose Pneumococcal Infections Diagnosis Sepsis Disseminated Intravascular Coagulation Etiology Female Humans Immunosuppressive Agents Adverse Effects Therapeutic Use Drug Therapy Necrosis Streptococcus Pneumoniae Isolation & Purification Young Adult Case Reports English Abstract Journal Article
Alternative Title	Sepsis with acral necrosis in a patient with Sharp syndrome - case 8/2010
Content Type	Text
Resource Type	Case study Article
Subject	Medicine

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