急性鼻窦炎继发中毒性休克综合征一例

摘要

Toxic shock syndrome is a characteristic infectious shock caused by the cytokine storm that results from massive activation of macrophages and CD4 + T cells in response to the release of superantigens by exotoxin-producing Staphylococcus aureus or Streptococcus pyogenes.Here,we report a case of toxic shock syndrome likely caused by Staphylococcus aureus-associated acute sinusitis.The main symptoms were high fe-ver,rash,conjunctival hyperaemia,pharynx hyperaemia,general edema,persistent hypotension,myalgia, pleural effusion,hepatic abnormality,urine protein,coagulation disorder,and hypoxemia.Multiple blood cul-tures,cultures of throat swabs,and the pleural effusion were all negative for pathogens.The patient had a rapid recovery after intravenous administration of linezolid and cefoperazone-sulbactam to control the infection and in-hibit the production of the superantigens,oral administration of glucocorticoids to suppress the immune response to the superantigens,and intravenous administration of gamma globulin to neutralize the superantigens.This re-sult suggests that in addition to sensitive antibiotics,agents that can decrease superantigen production,neutral-ize superantigens,and suppress the immune response activated by superantigens should also be administered to patients with toxic shock syndrome.%中毒性休克综合征是产外毒素的金黄色葡萄球菌或化脓性链球菌释放超抗原，诱导大量的巨噬细胞和 CD4＋T 细胞活化产生细胞因子风暴，导致的一种特征性感染性休克。该文报道1例急性鼻窦炎继发可能与金黄色葡萄球菌相关的中毒性休克综合征，表现为高热、皮疹、结膜充血、咽红、全身浮肿、持续性低血压、肌痛、胸腔积液、肝损伤、尿蛋白、凝血功能异常、低氧血症，多次血培养和咽拭子、胸水培养均阴性。给予利奈唑胺和头孢哌酮舒巴坦抗感染和抑制超抗原生成、静脉用丙种球蛋白中和超抗原、糖皮质激素抑制超抗原诱导的免疫反应等治疗很快痊愈。该文提示中毒性休克综合征不仅需要选择敏感的抗生素，还可以应用抑制超抗原生成、中和超抗原、抑制超抗原免疫反应的药物。