黄色い舌/暑い勉強部屋で凍りつく
・夏だから、レモンシロップがかかったかき氷をたべて舌が黄色くなることもあるでしょうが、その色はすぐとれますよね。NEJMのIMAGES IN CLINICAL MEDICINEに↓のようなレポートがありました
An Icteric Tongue
David Avelar Rodriguez, Julia Orkin.
N Engl J Med 2021; 385:e16 July 29, 2021
・まあ、黄色い舌と濃いオシッコの色だと、まず溶血かなとは考えましたが、それがEpstein–Barr virusによるものとは、「へーっ」です。ただEBV-induced acute hemolytic anemiaとPubMedに入れても↓の１件しかひっかかりませんでした。（Google Scholarだと逆にいっぱい）まれですよね。
J Emerg Med 2020 Feb;58(2):e71-e73.
A Rare Presentation of Epstein-Barr Virus Infection
John Teijido, Kelly Tillotson, J Marc Liu
Abstract
Background
Epstein–Barr virus (EBV) is a herpesvirus spread by intimate contact. It is known to cause infectious mononucleosis. Complications, including hematologic pathology and splenic rupture, are uncommon. This report is a case of EBV-induced autoimmune hemolytic anemia and biliary stasis.
Case Report
An 18-year-old man presented to the emergency department with abdominal pain, nausea, vomiting, and jaundice. He did not have risk factors for liver injury or hepatitis. His vital signs were notable for a fever. On examination, he was obviously jaundiced, but not in distress. Laboratory evaluation showed hemolytic anemia and biliary stasis. Ultimately, his inpatient workup yielded positive EBV serology and a positive direct agglutinin test with cold agglutinins. He made a full recovery with supportive care.
Why Should an Emergency Physician Be Aware of This?
EBV is a widely disseminated herpesvirus. Infectious mononucleosis is a common presentation of acute infection, and treatment of EBV-related diseases are largely supportive. Complications, such as splenic rupture and hematologic pathology, are uncommon. Biliary stasis and autoimmune hemolytic anemia in the form of cold agglutinin disease secondary to EBV is rare, and typically resolves with supportive care and cold avoidance. More advanced treatment methods are available in the setting of severe hemolysis. Elevated transaminases, direct hyperbilirubinemia, or evidence of hemolytic anemia in the setting of a nonspecific viral syndrome should raise suspicion for EBV infection. Rapid recognition can lead to more prompt prevention and treatment of other EBV-related complications.
Background
Epstein–Barr virus (EBV) is a herpesvirus spread by intimate contact. It is known to cause infectious mononucleosis. Complications, including hematologic pathology and splenic rupture, are uncommon. This report is a case of EBV-induced autoimmune hemolytic anemia and biliary stasis.
Case Report
An 18-year-old man presented to the emergency department with abdominal pain, nausea, vomiting, and jaundice. He did not have risk factors for liver injury or hepatitis. His vital signs were notable for a fever. On examination, he was obviously jaundiced, but not in distress. Laboratory evaluation showed hemolytic anemia and biliary stasis. Ultimately, his inpatient workup yielded positive EBV serology and a positive direct agglutinin test with cold agglutinins. He made a full recovery with supportive care.
Why Should an Emergency Physician Be Aware of This?
EBV is a widely disseminated herpesvirus. Infectious mononucleosis is a common presentation of acute infection, and treatment of EBV-related diseases are largely supportive. Complications, such as splenic rupture and hematologic pathology, are uncommon. Biliary stasis and autoimmune hemolytic anemia in the form of cold agglutinin disease secondary to EBV is rare, and typically resolves with supportive care and cold avoidance. More advanced treatment methods are available in the setting of severe hemolysis. Elevated transaminases, direct hyperbilirubinemia, or evidence of hemolytic anemia in the setting of a nonspecific viral syndrome should raise suspicion for EBV infection. Rapid recognition can lead to more prompt prevention and treatment of other EBV-related complications.
以下日記
・本日7/29（木）は、６時３分起床。朝勉して、猫たちに餌をやって朝食。そして出勤。今日はてっきり水島で午前外来だと思っていましたが、運転の途中なんか心配になって手帳を確認したら、ちがってた。先週の木曜日が休みで水島へ行っていなかったので、今日行く日だと思い込んでおりました。あぶないあぶない。と思って運転していたら、ガソリンがもうない。慌ててガソリンスタンドへ。そして無事玉島へ。午前外来、午後は倉敷市役所で公害健康被害認定審査会、それから玉島へ戻って回診し、ダッシュで帰宅。１８時からの『社会疫学』のZOOMでの学習会に参加するためです。１７時５０分に帰宅しセーフッ！と思ったのですが、何とＰＣのスイッチを入れてもUNともSUNとも言わない。あまりの暑さにPCが壊れたとかと思い、ノートパソコンを使用することに。設定にかなり時間がかかって１５分遅れでなんとか参加。議論に参加できました。ここで「重要な他者」という言葉を知りました。へーっ、です。それにしてもＰＣが立ち上がらなかった時は、ぞーとしました。学習会に参加できないことよりも、ハードディスク内のファイルが使えないことに恐怖を覚えました。しかーし、なんとコンセントが抜けていただけ。しかし、動かしてもいないのに何でコンセントがぬけるねん？鼠でもいるのか？
・まあ、安心してその後、猫たちに餌をやりに行ってから、入浴。夕食。餌をやりにいく前に配偶者に夕食のメニューを訊いたら「ポークカツができる予定」といわれて、帰ってきたら何とセセリの炒め物にかわっておりました。我が家のメニューは、食卓に上がるまで、わからない。何度も経験していても、驚きます。
・その後、某研究会の発表の抄録をかいて、PCで登録。そしてこのブログを書いております。これから歯磨きして寝ます。明日は、午前外来、午後から短い会議が三つと、住所の患者さんが転院してくる予定。いそがしーぞーっ！
・今日は、行き先間違い、ガソリン切れ寸前、PC起動せずと３回のヒヤッと夕食のメニューが短時間で変わっていたことの驚きと情動の動きが激しかった１日どした。
2021-07-29 22:07
nice!(0)
コメント(6)
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