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病例4-2018:一名出现血小板减少、白内障和肝脾大的新生儿
Case 4-2018 — A Newborn with Thrombocytopenia, Cataracts, and Hepatosplenomegaly


Robert S. Baltimore ... 其他 • 2018.02.08

先天性风疹综合征:当前罕见,但50年前肆虐美国的传染

 

杨琳,周文浩*

复旦大学附属儿科医院

*通讯作者

 

2017年1月24日NEJM.org刊登了一个扑朔迷离的新生儿罕见病病例1。现在,谜底发表在2月8日出版的《新英格兰医学杂志》“麻省总医院病例”专栏中。虽然该病病原已经在美国绝迹,在中国的发病率也由于疫苗接种而大大降低,但我们可以从中学到如何剥茧抽丝、切中要害。

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病历陈述


Madeleine I. Matthiesen医师(内科和儿科):一名新生男婴因血小板减少及眼部检查(红光反射)和听力筛查结果异常而转到本院新生儿重症监护治疗病房(ICU)。

在妊娠第39周+4日,一名27岁母亲(孕2,产2)在外院自然阴道分娩产下这名患儿,妊娠无并发症。患儿母亲在尼日利亚接受产前保健,在妊娠第24周+4日,在美国新英格兰地区接受过一次产科医师检查。在这次产前检查中,胎儿解剖结构的超声检查结果正常,人类免疫缺陷病毒(HIV)、乙型肝炎病毒、丙型肝炎病毒和梅毒的产前筛查结果均为阴性。母亲风疹病毒IgG抗体(>500 IU/mL;免疫参考范围,≥9.9 IU/mL)和水痘-带状疱疹病毒IgG抗体检查均为阳性。母亲ABO血型为O型,Rh阳性,红细胞抗体筛查阴性;血红蛋白电泳显示血红蛋白AS。





作者信息

Robert S. Baltimore, M.D., Katherine Nimkin, M.D., Katherine A. Sparger, M.D., Virginia M. Pierce, M.D., and Stanley A. Plotkin, M.D.
From the Departments of Pediatrics and Infection Prevention, Yale New Haven Children’s Hospital, and the Departments of Pediatrics and Epidemiology, Yale School of Medicine and Yale School of Public Health, New Haven, CT (R.S.B.); the Departments of Radiology (K.N.), Pediatrics (K.A.S., V.M.P.), and Pathology (V.M.P.), Massachusetts General Hospital, and the Departments of Radiology (K.N.), Pediatrics (K.A.S.), and Pathology (V.M.P.), Harvard Medical School — both in Boston; and the Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (S.A.P.).

 

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