幼儿急疹伴白细胞、中性粒细胞及血小板减少一例并文献复习

A Case of Roseola Infantum with Leukopenia, Neutropenia, and Thrombocytopenia, and Literature Review

摘要: 患儿，男，11月龄，因“发热4天”之代诉入院。病初时反复高热，热峰39.5℃，无咳嗽、抽搐，伴呕吐1次及稀糊状便4次，院外口服“头孢地尼、布洛芬混悬液、小儿柴桂退热颗粒”后体温仍反复。入院查体咽部稍充血、双肺呼吸音粗，其余无明显阳性体征。实验室检查提示白细胞1.40 × 10⁹/L、中性粒细胞绝对值0.27 × 10⁹/L、血小板33 × 10⁹/L；流感病毒IgM、呼吸道病原体核酸检测、EB病毒及巨细胞病毒DNA均阴性。住院第2天仍发热，热峰降至38.5℃，外周血异型淋巴细胞2%，粪隐血阳性；第3天体温平稳，颜面及躯干出现压之褪色的红色斑丘疹，呈典型“热退疹出”表现，皮疹于1~3天内消退；白细胞、中性粒细胞及血小板随之逐渐回升，住院第6天患儿症状体征明显消失出院，出院1周复查血常规基本恢复正常(白细胞5.55 × 10⁹/L，中性粒细胞绝对值1.09 × 10⁹/L，血小板420 × 10⁹/L)。临床诊断幼儿急疹，伴一过性白细胞、中性粒细胞及血小板减少。

Abstract: Patient, male, 11 months old, admitted to the hospital due to a proxy complaint of “fever for 4 days”. At the onset, he had recurrent high fever, peak fever of 39.5˚C, no cough or convulsions, accompanied by one vomiting episode and four instances of loose, pasty stools. After taking “cefdinil, ibuprofen suspension, and Pediatric Chai Gui fever-reducing granules” outside the hospital, his temperature remained fluctuating. Upon admission, aside from slight throat congestion and coarse breath sounds in both lungs, there were no obvious positive signs. Laboratory tests showed white blood cell count of 1.40 × 10⁹/L, absolute neutrophil count of 0.27 × 10⁹/L, platelet count of 33 × 109/L; Influenza virus IgM, respiratory pathogen nucleic acid testing, EB virus, and cytomegalovirus DNA were all negative. On the second day of hospitalization, fever persisted, fever peaked at 38.5˚C, peripheral blood atypical lymphocytes were 2%, and fecal occult blood was positive; On the third day, body temperature stabilized, and blanching red maculopapular rashes appeared on the face and trunk, showing the typical “fever subsidence and rash emergence” sign, with the rash subsiding within 1~3 days; White blood cells, neutrophils, and platelets gradually rebounded; on the sixth day of hospitalization, symptoms and signs disappeared significantly; after one week, blood count was basically normal (white blood cell count 5.55 × 10⁹/L, absolute neutrophil value 1.09 × 10⁹/L, platelet count 420 × 10⁹/L). Clinical diagnosis was roseola infantum, accompanied by transient leukopenia, neutrophils, and thrombocytopenia.