严重皮肤炭疽伴全身并发症：病例报告

摘要(中文译文)

本例中，我们描述了一例来自哈萨克斯坦的免疫功能正常成人发生的重型人类皮肤炭疽，并继发为伴菌血症、脓毒症、肺部受累及多器官功能障碍的全身型。患者为31岁男性，在屠宰过程中直接接触病畜后，右前臂出现进行性水疱和大疱性病变，伴有发热及广泛水肿。伤口渗出液和血液样本经PCR检测显示存在DNA，皮肤病变培养试验证实了诊断。尽管早期启动了抗菌治疗，患者仍发展为脓毒症、凝血异常、肝功能障碍及伴胸腔积液的双侧肺炎，需入住重症监护病房并升级抗菌及支持治疗。临床和实验室指标逐渐改善，患者康复且无远期并发症。本病例凸显了皮肤炭疽可能危及生命的全身性进展，强调了血液分子检测的诊断价值，并强调了对流行地区患者早期识别、密切监测和及时升级治疗的重要性。

Abstract

In this case, we describe a severe case of human cutaneous anthrax complicated by secondary generalized form with bacteremia, sepsis, pulmonary involvement, and multiorgan dysfunction in an immunocompetent adult from Kazakhstan. A 31-year-old male presented with a progressive vesicles and bullae lesion on the right forearm associated with fever, extensive edema, following direct contact with a sick animal during slaughter. Wound exudate and blood sample demonstrated the presence of DNA by PCR, and culture test of skin lesion confirmed the diagnosis. Despite early initiation of antimicrobial therapy, the patient developed sepsis, coagulation abnormalities, hepatic dysfunction, and bilateral pneumonia with pleural effusion, necessitating intensive care unit admission and escalation of antimicrobial and supportive treatment. Clinical and laboratory parameters gradually improved, and the patient recovered without late complications. This case highlights the potential for life-threatening systemic progression of cutaneous anthrax, emphasizes the diagnostic value of molecular detection of in blood, and underscores the importance of early recognition, close monitoring, and timely escalation of therapy in patients from endemic areas.

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