ﻪﻠﺠﻣ مﻮﻠﻋ يزار ﻲﻜﺷﺰﭘ هرود
19
، هرﺎﻤﺷ 94
، ﻦﻳدروﺮﻓ يرﺎﮕﻧ درﻮﻣ ﻪﻌﻟﺎﻄﻣ 1391
ﻪﻣﺪﻘﻣ ماد و نﺎـﺴﻧا ﻦﻴـﺑ كﺮﺘـﺸﻣ يرﺎﻤﻴﺑ ﻚﻳ زﻮﻠﺳوﺮﺑ ﺎـﺑ ﻢﻴﻘﺘـﺴﻣ ﺮـﻴﻏ ﺎﻳ ﻢﻴﻘﺘﺴﻣ سﺎﻤﺗ ﺮﺛا رد ﻪﻛ ﺖﺳا
ﻲـﻣ ﻞﻘﺘﻨﻣ نﺎﺴﻧا ﻪﺑ هدﻮﻟآ تﺎﻧاﻮﻴﺣ دﻮـﺷ
. زﻮﻠـﺳوﺮﺑ
روﺎـﺧ رد ﻲﻧﺎـﻬﺟ شﺮﺘـﺴﮔ ﺎـﺑ ﻲﻧاﻮﻴﺣ يرﺎﻤﻴﺑ ﻚﻳ و ﻲﺑﻮــﻨﺟ يﺎــﻜﻳﺮﻣآ ،ﻪــﻧاﺮﺘﻳﺪﻣ يﺎﻫرﻮــﺸﻛ ،ﻪــﻧﺎﻴﻣ ﺖﺳا يﺰﻛﺮﻣ يﺎﻴﺳآ )
1 .( ﺖـﺳا ﻦﻜﻤﻣ يرﺎﻤﻴﺑ ﻦﻳا
ﺮﻫ ﻊﻳﺎـﺷ رﻮـﻃ ﻪـﺑ ﺎﻣا ﺪﻨﻛ ﺮﻴﮔرد ار ﻲﺘﻓﺎﺑ ﺎﻳ نﺎﮔرا ﻢﺘـــﺴﻴﺳ و ناﻮﺨﺘـــﺳا ﺰـــﻐﻣ ،لﺎـــﺤﻃ ،ﺪـــﺒﻛ
لﺎﻴﻠﺗوﺪﻧاﻮﻟﻮﻜﻴﺗر (Reticuloendothelial)
ﺮﻴﮔرد ار
ﻲﻣ يراردا ﻢﺘﺴﻴﺳ ،ﺐﻠﻗ ﺖﺳا ﻦﻜﻤﻣ ترﺪﻧ ﻪﺑ ،ﺪﻨﻛ
ﺰﻴﻧ ار يﺰﻛﺮﻣ بﺎﺼﻋا ﻢﺘﺴﻴﺳ و ﻲﻠﺳﺎﻨﺗ ﺪﻨﻛ ﺮﻴﮔرد
) 2 و 3 ( . ناﻮـﻨﻋ ﺎـﺑ تﻻﺎـﻘﻣ رد ﺎﻣ تﺎﻌﻟﺎﻄﻣ سﺎﺳا ﺮﺑ
ﺑ
،زﻮﺒﻣوﺮﺗ وﻼﺳوﺮ 5
و ﻲـﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ درﻮﻣ 1
يﺰﻐﻣ ﺪﻳرو زﻮﺒﻣوﺮﺗ درﻮﻣ ﺖـﺳا هﺪـﺷ شراﺰﮔ
) 4 -
9 .( ﻲﻣ ﺮﻈﻧ ﻪﺑ زﻮﺒﻣوﺮﺗ درﻮﻣ ﻦﻴﻟوا شراﺰﮔ ﻦﻳا ﺪﺳر
ﺖﺳا ناﺮﻳا رد زﻮﻠﺳوﺮﺑ زا ﻲﺷﺎﻧ ﻲﻘﻤﻋ ﺪﻳرو .
درﻮﻣ ﻲﻓﺮﻌﻣ
هﺎــﻣ ﻦﻳدروﺮــﻓ رد 1390
يﺎــﻗآ ﻚــﻳ 28
ﻪﻟﺎــﺳ
ﺐﺗ ﻞﻴﻟد ﻪﺑ مﺮﻴﻤﺳ ﻦﻛﺎﺳ و ﻞﻫا راد ماد و زروﺎﺸﻛ
،
درد
، نﺎﺘـﺳرﺎﻤﻴﺑ ﻪـﺑ ﭗـﭼ يﺎـﭘ قﺎﺳ يﺰﻣﺮﻗو مرﻮﺗ
دﺮﻛ ﻪﻌﺟاﺮﻣ مﺮﻴﻤﺳ .
ماﺪـﻧا ﺮـﻄﻗ ﻲﻜﻳﺰﻴﻓ ﻪﻨﻳﺎﻌﻣ رد
ﻪﺘﻓﺎﻳ ﺶﻳاﺰﻓا قﺎﺳ ﻪﻴﺣﺎﻧ رد ﭗﭼ ﻲﻧﺎﺘﺤﺗ
، مﺮﮔ ، ﺰﻣﺮﻗ
ﻲﻧاﺪﻴﻣ ﻦﺴﺤﻣ ﺮﺘﻛد ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،يﺮﻴﺴﻣﺮﮔ و ﻲﻧﻮﻔﻋ يﺎﻫ يرﺎﻤﻴﺑ تﺎﻘﻴﻘﺤﺗ ﺰﻛﺮﻣرﺎﻳدﺎﺘﺳا:
نﺎﻬﻔﺻا
، ناﺮﻳا ،نﺎﻬﻔﺻا .
* ﺮﺘﻛد هدازﺮﻴﻣ شﻮﻧﺮﻓ :
ﺎﻬﻔﺻا ،نﺎﻬﻔﺻا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،يﺮﻴﺴﻣﺮﮔ و ﻲﻧﻮﻔﻋ يﺎﻫ يرﺎﻤﻴﺑ رﺎﻴﺘﺳد ن
، ناﺮﻳا . )
* لﻮﺌﺴﻣ هﺪﻨﺴﻳﻮﻧ [email protected](
ﺘﻛد ﻲﻗدﺎﺻ ﺎﺿﺮﻴﻠﻋ ﺮ :
،يژﻮﻟﻮﻜﻧا يژﻮﻟﻮﺗﺎﻤﻫ ﻲﺼﺼﺨﺗ قﻮﻓ رﺎﻴﺘﺳد مﻮﻠﻋ هﺎﮕﺸﻧاد
ناﺮﻳا ،نﺎﻬﻔﺻا ،نﺎﻬﻔﺻا ﻲﻜﺷﺰﭘ [email protected].
درﻮﻣ ﻚﻳ شراﺰﮔ ردﺎﻧ
زﻮﺒﻣوﺮﺗ ﺮﻫﺎﻈﺗ ﺎﺑ زﻮﻠﺳوﺮﺑ ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﻴﺑ ﻲﻧﺎﺘﺤﺗ ماﺪﻧا ﻲﻘﻤﻋ ﺪﻳرو
هﺪﻴﻜﭼ فﺪﻫ و ﻪﻨﻴﻣز :
و هدﻮـﺑ ﻊﻳﺎـﺷ ناﺮـﻳا ﻪﻠﻤﺟ زا ﻪﻌﺳﻮﺗ لﺎﺣ رد يﺎﻫرﻮﺸﻛ رد ﻪﻛ ﺖﺳا مادو نﺎﺴﻧا ﻦﻴﺑ كﺮﺘﺸﻣ يرﺎﻤﻴﺑ ﻚﻳ زﻮﻠﺳوﺮﺑ ﻞﻜـﺸﻣ ﻚـﻳ ناﻮـﻨﻋ ﻪـﺑ
ﺖﺳا حﺮﻄﻣ ﻢﻬﻣ ﻲﺘﺷاﺪﻬﺑ .
ﺎﺑ هاﺮﻤﻫ ﺪﻳرو و نﺎﻳﺮﺷ هﺪﻨﻨﻛﺮﻴﮔرد ﻲﻗوﺮﻋ ضراﻮﻋ ﺖﺳا هﺪﺷ شراﺰﮔ ترﺪﻧ ﻪﺑ زﻮﻠﺳوﺮﺑ
. ﺮـﻈﻧ ﻪـﺑ نﻮـﺘﻣرد هﺪﺷ مﺎﺠﻧا ﻲﺳرﺮﺑ رد
ﻲﻣ
ﺖـﺳا هﺪـﺷ شراﺰﮔ زﻮﻠﺳوﺮﺑ ﺎﺑ هاﺮﻤﻫ يﺰﻐﻣ ﺪﻳرو زﻮﺒﻣوﺮﺗ درﻮﻣ ﻚﻳو ﻲﻧﺎﺘﺤﺗ ماﺪﻧا ﻲﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ درﻮﻣ ﺞﻨﭘ زوﺮﻣا ﺎﺗ ﺪﺳر .
درﻮـﻣ ﻚـﻳ ﻪـﻟﺎﻘﻣ ﻦـﻳا رد
دﺎﺣ زﻮﻠﺳوﺮﺑ ﺎﺑ هاﺮﻤﻫ ﭗﭼ ﻲﻧﺎﺘﺤﺗ ماﺪﻧا ﻲﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ ﺖﺳا هﺪﺷ شراﺰﮔ
. زﻮﻠـﺳوﺮﺑ زا ﻲﺷﺎﻧ ﻲﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ درﻮﻣ ﻦﻴﻟوا شراﺰﮔ ﻦﻳا ﺪﺳر ﻲﻣ ﺮﻈﻧ ﻪﺑ
ﺖﺳا ناﺮﻳا رد .
درﻮﻣ ﻲﻓﺮﻌﻣ :
ﻲﻳﺎﻗآ رﺎﻤﻴﺑ 28 ﺐﺗ ﻲﻨﻴﻟﺎﺑ يﺎﻫ ﻪﺘﻓﺎﻳ ﺎﺑ ﻪﻛ ﺖﺳا ﻪﻟﺎﺳ ،
و درد ﺪـﻳرو زﻮـﺒﻣوﺮﺗ ماﺪﻧا زا ﺮﻠﭘاد ﻲﻓاﺮﮔﻮﻧﻮﺳ رد و دﺮﻛ ﻪﻌﺟاﺮﻣ ﭗﭼ ﻲﻧﺎﺘﺤﺗ ماﺪﻧا مرﻮﺗ
دﺎﻘﻌﻧا ﺪﺿ يوراد ﺎﺑ نﺎﻣرد ﺖﺤﺗ رﺎﻤﻴﺑ و ﺪﺷ شراﺰﮔ ﻲﻘﻤﻋ ﺖﻓﺮﮔ راﺮﻗ
. نﺎﻣرد ﻪﻣادا ﺎﺑ و ﻲﻧﺎﺘﺤﺗ ماﺪﻧا درد ﺶﻫﺎﻛ و ﺐﺗ لﺮﺘﻨﻛ ﺎﺑ ﺎﺑ
ﺪﺷ ﺺﺧﺮﻣ رﺎﻤﻴﺑ ﻦﻳرﺎﻓراو .
ﻳﺮﻌﺗ و ﺐﺗ دﺪﺠﻣ زوﺮﺑ ﺎﺑ رﺎﻤﻴﺑ يﺮﻴﮕﻴﭘ ﻲﻃ ﻮﻧاز ود مرﻮﺗ ،ﻲﻧﻼﻀﻋ درد ،ﻖ
ﻪـﺑ ﻚـﺷ ﺎـﺑ هاﺮـﻤﻫ ﻢﻳﻼﻋ و رﺎﻤﻴﺑ يژﻮﻟﻮﻴﻣﺪﻴﭘا ﺖﻴﻌﺿو ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻪﻛ دﺮﻛ ﻪﻌﺟاﺮﻣ
زﻮﻠﺳوﺮﺑ
، زﻮﻠﺳوﺮﺑ ﺺﻴﺨﺸﺗ ﺎﺑ و ﺖﺒﺜﻣ ﻻﺎﺑ ﺮﺘﻴﺗ ﺎﺑ ﻪﻛ ﺪﺷ ﺖﺳاﻮﺧرد يژﻮﻟوﺮﺳ ،
ﺖﻓﺮﮔ راﺮﻗ نﺎﻣرد ﺖﺤﺗ .
رﺎﻤﻴﺑ نﺎﻣرد ﻪﻣادارد ،دﺮـﻛ ﻪﻌﺟاﺮﻣ نﺎﺘﺳرﺎﻤﻴﺑ ﻪﺑ ادﺪﺠﻣ
ﺎﺑ رﺎﺑ ﻦﻳا ﻪﻓﺮﺳ ،ﻲﻧﺎﻬﮔﺎﻧ ﺲﻔﻧ ﻲﮕﻨﺗ ﻢﻳﻼﻋ ،
ﻚﻴﺗرﻮﻠﭘ درد و ﻲﻧﻮﺧ ﻂﻠﺧ (pleuritic )
ﻪﻛ ﻪﻨﻴﺳ ﻪﺴﻔﻗ و ﺪـﺷ حﺮـﻄﻣ ﻪﻳر ﻲﻟﻮﺒﻣآ ﻪﻨﻴﺳ ﻪﺴﻔﻗ ﻦﻜﺳا ﻲﺗ ﻲﺳ رد
ﺖﻓﺮﮔ راﺮﻗ نﺎﻣرد ﺖﺤﺗ و يﺮﺘﺴﺑ هرﺎﺑود رﺎﻤﻴﺑ .
اد ﺪﻨﭼ نﺎﻣرد و ﻦﻳرﺎﻓراو ﺎﺑ نﺎﻣرد ﻪﺑ رﺎﻤﻴﺑ ﺖﻳﺎﻬﻧ ردو ﺪﺷ در ﺖﻴﺒﻠﻓﻮﺒﻣوﺮﺗ ﻞﻠﻋ ﺮﻳﺎﺳ يﺮﺘﺴﺑ ﺮﻴﺳ رد ﺪـﺿ ﻲﻳور
داد ﺐﺳﺎﻨﻣ ﻲﻨﻴﻟﺎﺑ ﺦﺳﺎﭘ زﻮﻠﺳوﺮﺑ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ : ﺖﺳا يروﺮﺿ نآ زﺎﺳ ﻞﻜﺸﻣ ضراﻮﻋ زا يﺮﻴﮕﺸﻴﭘ ﺖﻬﺟ زﻮﻠﺳوﺮﺑ ﺐﺳﺎﻨﻣ نﺎﻣرد و سردوز ﺺﻴﺨﺸﺗ .
ﻲـﻠﺒﻗ ﻪﺑﺎـﺸﻣ دراﻮـﻣ و رﺎﻤﻴﺑ ﻦﻳا ﻲﻓﺮﻌﻣ
،ﺪﻨﻨﻛ ﻲﻣ ﻪﻌﺟاﺮﻣ ﻲﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ ﺎﺑ ﻪﻛ ﻲﻧارﺎﻤﻴﺑ رد ﻪﻛ ﺪﻫد ﻲﻣ ﺮﻛﺬﺗ ار ﺐﻠﻄﻣ ﻦﻳا ﻪﺑ ﻪﺟﻮﺗ ﻪﺑ
ﺪﻨﺷﺎﺑ ﻲﻣﻮﺑ ﻖﻃﺎﻨﻣ زا ﺮﮔا صﻮﺼﺧ ،
ﺪﺷﺎﺑ ﺮﻈﻧ ﺪﻣ زﻮﻠﺳوﺮﺑ .
هژاو ﺪﻴﻠﻛ ﺎﻫ : ﻲﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ ،زﻮﻠﺳوﺮﺑ
، ﻪﻳر ﻲﻟﻮﺒﻣآ . ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ :
26 / 9 / 90 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :
22 / 12 / 90
درﻮﻣ ﻚﻳ شراﺰﮔ ردﺎﻧ
زﻮﻠﺳوﺮﺑ ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﻴﺑ ...
ﻪﻠﺠﻣ مﻮﻠﻋ يزار ﻲﻜﺷﺰﭘ
هرود 19 هرﺎﻤﺷ ، 94 ﻦﻳدروﺮﻓ ، 1391
41
ﻪﺘﻴﻠﭘﻮﭘ ﺪﻳرو زﻮﺒﻣوﺮﺗ .2 و1 ﺮﻳﻮﺼﺗ
ﻪﻳر ﻲﻟﻮﺒﻣآ-4 و3 ﺮﻳﻮﺼﺗ
دﻮــﺑ سﺎــﺴﺣ ﺲــﻤﻟ رد و .
ماﺪــﻧاﺮﻠﭘاد ﻲﻓاﺮﮔﻮﻧﻮــﺳ
ﺗ ﻪﺘﻴﻠﭘﻮﭘ ﺪﻳرو زﻮﺒﻣوﺮﺗ ﭗﭼ ﻲﻧﺎﺘﺤ
دﺮـﻛ شراﺰـﮔ ار
) ﺮﻳﻮﺼﺗ 1 و 2 ( . ﻪﺑ و ﻦﻳرﺎﭘﺎﺴﻛﻮﻧا ﺎﺑ نﺎﻣرد ﺖﺤﺗ رﺎﻤﻴﺑ
ﺖـﻓﺮﮔ راﺮـﻗ ﻦﻳرﺎـﻓراو نآ لﺎـﺒﻧد .
ﺐـﺗ لﺮـﺘﻨﻛ ﺎـﺑ ،
ﻦﻳرﺎـﻓراو نﺎﻣرد ﻪﻣادا ﺎﺑ و ﻲﻧﺎﺘﺤﺗ ماﺪﻧا درد ﺶﻫﺎﻛ ﺪﺷ ﺺﺧﺮﻣ رﺎﻤﻴﺑ .
دﺪـﺠﻣ زوﺮﺑ ﺎﺑ رﺎﻤﻴﺑ يﺮﻴﮕﻴﭘ ﻲﻃ
ود مرﻮـﺗ ،ﻲﻧﻼـﻀﻋ درد ،ﻖﻳﺮﻌﺗ و ﺐﺗ ﻪـﻌﺟاﺮﻣ ﻮـﻧاز
و رﺎـﻤﻴﺑ يژﻮﻟﻮﻴﻣﺪـﻴﭘا ﺖﻴﻌـﺿو ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻪﻛ دﺮﻛ يژﻮﻟوﺮــﺳ زﻮﻠــﺳوﺮﺑ ﻪــﺑ ﻚــﺷ ﺎــﺑ هاﺮــﻤﻫ ﻢــﻳﻼﻋ دﻮﺑ ﺮﻳز حﺮﺷ ﻪﺑ تﺎﺸﻳﺎﻣزآ ﺞﻳﺎﺘﻧ ،ﺪﺷ ﺖﺳاﻮﺧرد :
Wright:1/640, Coombs wright:1/1280, 2ME:1/640
ﻲﺳرﺮﺑ ﺮﻳﺎﺳ ﺞﻳﺎﺘﻧ دﻮﺑ ﺮﻳز راﺮﻗ ﻪﺑ ﺰﻴﻧ ﺎﻫ
:
ANA: Neg, PPD: Neg,
Anti-phospholipid antibody: IgM: 2, IgG:2 Lupus anticoagulant: Neg
و نﺎـﻣرد ﺖﺤﺗ زﻮﻠﺳوﺮﺑ ﺺﻴﺨﺸﺗ ﺎﺑ رﺎﻤﻴﺑ ﺖﻳﺎﻬﻧ رد
ﻦﻴﻠﻜﻴﺳ ﻲﺴﻛاد ﺎﺑ ،
راﺮﻗ ﻦﻴﺴﻳﺎﻣﻮﺘﭘﺮﺘﺳاو ﻦﻴﭙﻣﺎﻔﻳر
ﺖﻓﺮﮔ . و ﻦﻴﭙﻣﺎﻔﻳر ﻲﻳوراد ﻞﺧاﺪﺗ لﺎﻤﺘﺣا ﻪﺑ ﻪﺟﻮﺗﺎﺑ
ﺼﺨﺘﻣ ﺮﻈﻧ ﺎﺑ ﻦﻳرﺎﻓراو ﻪﻳر ﺺ
ﻻﺎـﺑ زود ﺎـﺑ ﻦﻳرﺎﻓراو,
ﺪــﺷ ﺰﻳﻮــﺠﺗ .
ﻪــﺑ دﺪــﺠﻣ رﺎــﻤﻴﺑ نﺎــﻣرد ﻲــﻃ رد
ﻲـﮕﻨﺗ ﻢـﻳﻼﻋ ﺎـﺑ رﺎـﺑ ﻦـﻳا ،دﺮﻛ ﻪﻌﺟاﺮﻣ نﺎﺘﺳرﺎﻤﻴﺑ
،ﻪﻓﺮﺳ ،ﻲﻧﺎﻬﮔﺎﻧ ﺲﻔﻧ ﻚـﻴﺗرﻮﻠﭘ درد و ﻲﻧﻮـﺧ ﻂﻠﺧ
رد ﻪﻛ ﻪﻨﻴﺳ ﻪﺴﻔﻗ Chest spiral CT
ﻪـﻳر ﻲﻟﻮـﺒﻣآ
ﺪﺷ حﺮﻄﻣ )
ﺮﻳﻮﺼﺗ 3 و 4 ( و يﺮﺘـﺴﺑ هرﺎـﺑود رﺎـﻤﻴﺑ و
ﺖﻓﺮﮔ راﺮﻗ نﺎﻣرد ﺖﺤﺗ .
نﺎـﻣرد ﻪﺑ رﺎﻤﻴﺑ ﺖﻳﺎﻬﻧ رد
زﻮﻠـﺳوﺮﺑ ﺪـﺿ ﻲـﻳوراد ﺪـﻨﭼ نﺎـﻣرد و ﻦﻳرﺎﻓراو ﺎﺑ ،
ﺮﺘﻴﺗ و داد ﺐﺳﺎﻨﻣ ﻲﻨﻴﻟﺎﺑ ﺦﺳﺎﭘ نﺎـﻣرد ﻲـﻃ2ME
ﺖﻓﺎﻳ ﺶﻫﺎﻛ .
ﺚﺤﺑ ﻪﺠﻴﺘﻧ و يﺮﻴﮔ
زﻮﻠــﺳوﺮﺑ )
ﺖــﻟﺎﻣ ﺐــﺗ (
يرﺎــﻤﻴﺑ ﻪــﻠﻤﺟ زا يﺎــﻫ
ﻲـﻣ ﻪﻛ دﻮﺷ ﻲﻣ بﻮﺴﺤﻣ ناﺮﻳا ﻚﻴﻣﺪﻧآ ﺗ
ﺎـﺑ ﺪـﻧاﻮ
نﺎـﮔرا يﺮﻴﮔرد يﺎـﻫ مرﺪﻨـﺳ نﺪـﺑ ﻒـﻠﺘﺨﻣ يﺎـﻫ
ﺪـﻳﺎﻤﻧ دﺎـﺠﻳا ار يدﺪـﻌﺘﻣ ﻲﻨﻴﻟﺎﺑ .
ﻲـﺒﻠﻗ ضراﻮـﻋ -
رد ﺎـﻬﻨﺗ و ردﺎﻧ زﻮﻠﺳوﺮﺑ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ رد ﻲﻗوﺮﻋ 1 - 2 % ﺪﺘﻓا ﻲﻣ قﺎﻔﺗا دراﻮﻣ )
10 .(
ﻪﺿرﺎﻋ ﻦﻳﺮﺗ ﻊﻳﺎﺷ
ﻲﺒﻠﻗ -
و ﻲﻌﻴﺒﻃ ﻪﭽﻳرد ﺖﻳدرﺎﻛوﺪﻧا زﻮﻠﺳوﺮﺑ ﻲﻗوﺮﻋ
ﺖﺳا ﻲﻋﻮﻨﺼﻣ )
11 - 13 .(
ﺶﻴﺑ ﺖﻳدرﺎﻛوﺪﻧا رد ﻦﻳﺮﺗ
،ﺮﻴﮔرد ﻪﭽﻳرد ﻪﭽﻳرد
ﺗرﻮﺋ آ رد،ﺖﺳﺎ ﻼﺘـﺒﻣ نارﺎﻤﻴﺑ
ﻊﻳﺎـﺷ ﺰـﻴﻧ يا ﻪـﭽﻳرد ﺪـﻨﭼ يﺮـﻴﮔرد زﻮﻠـﺳوﺮﺑ ﻪﺑ ﻲﻣ و ﺖـﺳا زﻮﻠﺳوﺮﺑ ﻪﺿرﺎﻋ ﻦﻳﺮﺗ كﺎﻧﺮﻄﺧ ﻪﻛ ﺪﺷﺎﺑ
5 % ﻞﻣﺎــﺷ ار ﻲﻧﺎــﺴﻧا زﻮﻠــﺳوﺮﺑ ﺮــﻴﻣو گﺮــﻣ ﻞــﻛ
ﻲﻣ دﻮﺷ ) 14 .( ﻊﻳﺎﺷ ﻪﻧﻮﮔ ﻦﻳﺮﺗ اﺪـﺟ يﻼـﺳوﺮﺑ يﺎﻫ
ﺮﺘﻛد ﻲﻧاﺪﻴﻣ ﻦﺴﺤﻣ نارﺎﻜﻤﻫ و
ﻪﻠﺠﻣ مﻮﻠﻋ يزار ﻲﻜﺷﺰﭘ
هرود 19
، هرﺎﻤﺷ 94
، ﻦﻳدروﺮﻓ 1391
42
ﻲﺒﻠﻗ يﺎﻫ يرﺎﻤﻴﺑ رد هﺪﺷ -
سﻮﺗرﻮﺑا ﻼﺳوﺮﺑ ﻲﻗوﺮﻋ
ﺖﺳا ﺲﻴﺴﻨﺘﻴﻠﻣ و )
2 .(
رو زﻮﺒﻣوﺮﺗ ﻚـﻳ زﻮﻠـﺳوﺮﺑ رد ﺖﻴﺒﻠﻓﻮﺒﻣوﺮﺗ و يﺪﻳ
ﺎـﻬﻨﺗ زوﺮـﻣا ﺎـﺗ و ﺖـﺳا ردﺎـﻧ ﺖـﻳﺎﻬﻧ ﻲـﺑ ﻪﺿرﺎﻋ 6
نآ زا ﻪـﻛ ﻪﺘـﺷاد دﻮـﺟو هرﺎـﺑ ﻦﻳا رد درﻮﻣ شراﺰﮔ ﻲﻣ ﻪﻠﻤﺟ يﺎﻗآ درﻮﻣ شراﺰﮔ ﻪﺑ ناﻮﺗ
هرﺎـﺷا ﺶﻴﻤﻣ
دﺮﻛ : ﻲﻳﺎﻗآ 41 لﺎـﺣ حﺮﺷ ﺎﺑ ﻪﻟﺎﺳ 8
ﭻـﻣ درد هزور
زا ﺪـﻌﺑ رﺎـﻤﻴﺑ درد ﻪﻛ ﺖﺳار يﺎﭘ 3
ﻪـﻴﺣﺎﻧ ﻪـﺑ زور
قﺎﺳ ﺖﻓﺎﻳ شﺮﺘﺴﮔ .
،ﺐﺗ زا يا ﻪﻨﻴﻣز يور ﺎﭘ ﻢﻳﻼﻋ
ﺪﺷ دﺎﺠﻳا زﺮﻟو ﻖﻳﺮﻌﺗ .
دﻮـﺑ لﺎـﻣﺮﻧ ماﺪﻧا ﻲﻓاﺮﮔ
، ﺎـﻣا
نﺎـﺸﻧ ار ﺖـﺳار قﺎـﺳ ﻲﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ ماﺮﮔﻮﻧو داد . ﺪـﺷ شراﺰﮔ ﻲﻔﻨﻣ يو نﻮﺧ ﺖﺸﻛ ﻪﭼﺮﮔا
، ﺎـﻣا
دﻮـﺑ ﻻﺎـﺑ ﻼـﺳوﺮﺑ ﺪـﺿ يدﺎﺑ ﻲﺘﻧآ ﺮﺘﻴﺗ .
ﺎـﺑ نﺎـﻣرد
ﻲـﺴﻛاد هرود ﻚﻳ و دﺎﻘﻌﻧا ﺪﺿ يوراد -
ﻜﻳﺎـﺳ و ﻦﻴﻠ
ﺪﺷ رﺎﻤﻴﺑ دﻮﺒﻬﺑ ﺚﻋﺎﺑ ﻦﻴﭙﻣﺎﻔﻳر يﺮﮕﻳد شراﺰﮔ رد.
ﺰﻴﻧ ﻪﺑ ﻲﻧﺎـﺘﺤﺗ ماﺪﻧا ﻲﻘﻤﻋ ﺪﻳرو زﻮﺒﻣوﺮﺗ درﻮﻣ ﻚﻳ
ﻲﻳﺎﻗآ رد ﺖﺳار 51
زﻮﻠـﺳوﺮﺑ ﻪـﺑ ﻼﺘﺒﻣ ﻪﻟﺎﺳ هرﺎـﺷا
دﺎـﻘﻌﻧا ﺪـﺿ و ﻼﺳوﺮﺑ ﻲﺘﻧآ نﺎﻣرد ﻪﺑ ﻪﻛ ﺖﺳا هﺪﺷ داد ﺦــﺳﺎﭘ .
ﻼــﺳوﺮﺑ رد ﺖــﻴﺒﻠﻓﻮﺒﻣوﺮﺗ و زﻮــﺒﻣوﺮﺗ
ﻲــﻣ ﻞــﺜﻣ ﻲــﻔﻠﺘﺨﻣ ﻞــﻳﻻد ﻪــﺑ ﺪــﻧاﻮﺗ ﺖﻴﺒﻠﻓوﺪــﻧا
ﻪـﺑ گر فاﺮـﻃا ﺖﻓﺎﺑ ﺐﻴﺳآ و بﺎﻬﺘﻟا ،زﻮﺗﺎﻣﻮﻟﻮﻧاﺮﮔ
،مﺮـﻧ ﺖـﻓﺎﺑ ﺎـﻳ ﻪـﺴﺑآ رﺎﺸﻓ ،ﺖﻧﻮﻔﻋ ﻪﻠﻴﺳو ﺶﻳاﺰـﻓا
دﺎﻘﻌﻧا ﺮـﺑاﺮﺑ رد ﻲـﻨﻤﻳا ﺶﻨـﻛاو ﺎـﻳ و ارﺬـﮔ يﺮﻳﺬـﭘ
ﻲﺘﻧآ ﺪﺘﻔﻴﺑ قﺎﻔﺗا ﻼﺳوﺮﺑ نژ )
15 و 16 .(
و ﻲﻓاﺮﮔﻮـﻳﮋﻧآ
قوﺮـﻋ يﺮـﻴﮔرد ﺺﻴﺨﺸﺗ ياﺮﺑ ﻲﻓاﺮﮔﻮﻧﻮﺳ ﺮﻳوﺎﺼﺗ هﺪﻨﻨﻛ ﻚﻤﻛ زﻮﻠﺳوﺮﺑ رد ﺪﻧا
) 1 .(
ﺪـﺳر ﻲـﻣ ﺮـﻈﻧ ﻪﺑ
ﻲـﻘﻤﻋ ﺪـﻳرو زﻮـﺒﻣوﺮﺗ ﻞﻜـﺷ ﻪـﺑ ﻲـﻗوﺮﻋ يﺮﻴﮔرد DVT=Deep Venous Thrombosis) (
زا ﻲــﺷﺎﻧ
ﻊﻳﺎﺷ زﻮﻠﺳوﺮﺑ ﺖﺴﻴﻧ
، ﻲﻣ ﺎﻣا ﻲﻣﻮـﺑ ﻖﻃﺎﻨﻣ رد ﺪﻧاﻮﺗ
دﻮﺷ هﺪﻳد ﻊﻳﺎﺷﺎﻧ ﻢﻳﻼﻋ ﺮﮕﻳد ﺪﻨﻧﺎﻤﻫ .
ﺪـﻳرو زﻮـﺒﻣوﺮﺗدرﻮﻣ رد يردﺎـﻧ تﺎـﺷراﺰﮔ ﻪﭼﺮﮔا ﻲﻣ هﺪﻳد زﻮﻠﺳوﺮﺑ زا ﻲﺷﺎﻧ ﻲﻘﻤﻋ دﻮﺷ
، ﻲﺣاﻮﻧ رد ﺎﻣا
ﻦﻴـﻨﭼ ﺎـﺑ درﻮـﺧﺮﺑ رﺎـﻈﺘﻧا زﻮﻠـﺳوﺮﺑ يﻻﺎﺑ عﻮﻴﺷ ﺎﺑ ﺎﺑ ﻲﻣﻮﺑ ﻖﻃﺎﻨﻣ نارﺎﻤﻴﺑ رد اﺬﻟ ،دراد دﻮﺟو ﻲﻧارﺎﻤﻴﺑ رد ار زﻮﻠـﺳوﺮﺑ ﻲﺘﺴﻳﺎﺑ ﺐﺗ و ﻲﻗوﺮﻋ ﻲﺒﻠﻗ تﻼﻜﺸﻣ ﻢﻴﻫد راﺮﻗ ﺮﻈﻧ ﺪﻣ ﻲﻗاﺮﺘﻓا ﺺﻴﺨﺸﺗ .
ﻊﺑﺎﻨﻣ
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2. Franco MP, Mulder M,Gilman RH,Smits HL.
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281-83.
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6. Marfil-Rivera LJ, Marez-Ramirez MA, Mora- Brondo P, Rivera-Gonzalez JA, Gomez Almaquer D. Deep venous thrombosis in a patient with Brucellosis and a probable lupoid inhibitor. Rev Invest Clin 1986;38:311-35.
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12. Geyik MF, Kokoglu of, Hosoglu S, Ayaz C.
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[Turkish].
14. Uddin MJ, Sanyal SC, Mustafa AS, Mokaddas EM, Salama AL, Cherian G. The role of aggressive medical therapy along with early surgical intervention in the care of brucella endocarditis Ann Thorac Cardio Vasc Surg 1998;4:209-13.
15. Sanchez-Gonzales J, Garcia-Delange T, Martos F, Calmenero JD. Thrombosis of the abdominal aorta secondary to brucella spondylitis.
Infection 1996;24:261-62.
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Harper And Row;1983.pp.1212-19.
Case Study
Razi Journal of Medical Sciences Vol. 19, No. 94, Mar-Apr 2012 43
Simultaneous deep vein thrombosis and acute brucellosis: case report
Mohsen Meidani, MD. Assistant Professor of Infectious Diseases, Tropical and Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. [email protected]
*Farnoosh Mirzadeh, MD. Resident of Infectious Diseases, Tropical and Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. (*Corresponding author) [email protected].
Alireza Sadeghi, MD. Fellowship of Hematology-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract
Background:Brucellosis is a zoonotic disease that is common in developing countries such as Iran which is a serious medical impact. Vascular complications, including arterial and venous associated with Brucella infection, have rarely been reported. In a review of articles, it is clear that , only five cases of deep venous thrombosis (DVT) of the lower extremities and just one case of cerebral venous thrombosis, associated with brucellosis have been reported so far. In this article a case of DVT of the left leg in association with acute Brucella infection was reported. Apparently, this case report is the first case of DVT due to brucellosis in Iran.
Case presentation: Patient is a 28-year-old male who presented with clinical manifestations of fever, unilateral calf pain and swelling. Peripheral venous doppler ultrasound showed DVT and patient was treated with anti coagulants. Through controlling the fever and decreasing the lower extremity. The patient discharged with warfarin therapy. During follow up, the patient came back with repeated fever, sweating, myalgia and bilateral knee swelling. Because of patient clinical manifestation and epidemiologic status, brucellosis serology test was recommended, which was positive in high titer. He was discharged with a prescription of anti-brucellosis treatment. In the course of treatment, the patient referred to hospital due to sudden dyspnea, cough, hemoptysis , pleuretic chest pain. In spiral CT with protocol PTE, pulmonary thrombo emboli was detected and standard therapy for PTE was administered. In the course of his hospitalization other etiologies of thrombo phelebitis were excluded. Finally, the patient's clinical presentation subsided with warfarin therapy and anti brucellosis multi drug regimen.
Conclusion: Early detection and appropriate treatment of Brucellosis are crucial measures to prevent problematic complications of the disease. The authors' case and those previously reported, suggest that brucellosis should be included among the etiologies and the infections which are taken into account in patients suffering from DVT, particularly in those coming from Brucella-endemic areas.
Keyword: Brucellosis, Deep venous thrombosis, Pulmonary thromboemboli.
