Случай тромбоза воротной вены и ее ветвей у пациента, серопозитивного по антигенам боррелий - Журнал Терапевтический архив № 11 Инфекционные болезни 2018

Случай тромбоза воротной вены и ее ветвей у пациента, серопозитивного по антигенам боррелий

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Аннотация

Представлен случай тромбоза воротной вены и ее ветвей у пациента, серопозитивного по антигенам боррелий. Пациент 34 лет с хроническим гастритом, ассоциированным с хеликобактерной инфекцией, и желчнокаменной болезнью в анамнезе был госпитализирован в связи с развитием болей в эпигастральной области и лихорадкой до 38,7°С в течение 11 дней после пикника в лесу без зарегистрированного присасывания клеща. При мультиспиральной компьютерной томографии органов брюшной полости выявлен тромбоз воротной вены и ее ветвей. Гематологическая, онкологическая, ревматологическая патология не выявлены, данных за тромбофилию не выявлено. При иммунофлюоресцентном анализе выявлен высокий уровень антител к Borrelia burgdorferi IgM 62,2 U/мл с увеличением до 190 U/мл. В иммуноблоттинге были обнаружены антитела к Borrelia IgM к OspA, p31 и OspC, p25. Через 2 нед после антикоагулянтной, антибактериальной и дезинтоксикационной терапии симптоматика регрессировала, при контрольной томографии тромбоз воротной вены и ее ветвей не выявлен. У пациентов с лихорадной неясного генеза и тромбозом воротной вены и ее ветвей при наличии эпидемиологического анамнеза целесообразен скрининг на антигены Borrelia.

Ключевые слова: боррелиоз, болезнь Лайма, тромбоз, Borrelia burgdorfery, нейроборрелиоз.

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Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Thrombosis of the portal vein represents a significant problem too with high morbidity and mortality. The risk factors for splanchnic vein thrombosis include infections, but its relationship with borreliosis has not been studied. А 34-year-old man with chronic helicobacter-associated gastritis and gallstones was hospitalized due to development during the last 11 days of epigastric pain and fever to 38.7 °C after a picnic at the forest without a registered tick bite. The blood leukocytes were increased to 11.2*109/l, lymphocytes 70%, C-reactive protein 34.6 mg/l, procalcitonin 0.195 ng/ml. The multispiral computed tomography of the abdominal cavity revealed thrombosis of portal, lienalis and superior mesenteric veins. D-dimer was 1.98 mcg/ml, antithrombin III 75%. JACK2V617F, oncological, rheumatic, thrombophilia markers, blood and urine cultures were negative. A high concentration of anti-Borrelia burgdorferi IgM 62.2 U/ml and its increasing to 190 U/ml in dynamics was revealed at the immunofluorescence assay. Anti-Borrelia IgM to OspA, p31 and OspC, p25 were detected at the immunoblotting assay. Anticoagulation, doxycycline, detoxification therapy reduced pain and normalized temperature and inflammation markers. Vein thrombosis was not detected at the control tomography after 2 weeks. Despite that the combination of thrombosis and borreliosis is rare, it is necessary to screen for Borrelia antigens in patients with splanchnic vein thrombosis and fever.

Keywords: borreliosis, Lyme disease, thrombosis, Borrelia burgdorfery, neuroborreliosis..

Список литературы

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1. Joanna Zajkowska, Piotr Lewczuk, Franc Strle, Gerold Stanek Lyme Borreliosis: From Pathogenesis to Diagnosis and Treatment. Clin Dev Immunol. 2012July; 2012:231657. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3449121/ accessed Oktober 3, 2017
2. Prof Gerold HYPERLINK "jav * ascript:void(0);" Stanek, Prof Gary P HYPERLINK "jav * ascript:void(0);"Wormser, MD,ProfJeremy HYPERLINK "jav * ascript:void(0);" Gray, PhD,ProfFrancStrle, MD Lyme borreliosis. 2011 September;379(9814):461-73. http://www.thelancet.com/ journals/lancet/article/PIIS0140-6736(11)60103-7/fulltext accessed September 30, 2017
3. Singha SK, Girschick HJ. Lyme borreliosis: from infection to autoimmunity. Clinical Microbiology and Infection. July 2004;10(Issue 7):598-614. http://www.sciencedirect.com/science/article/pii/ S1198743X14628871 accessed Oktober 17, 2017
4. [Lime-borreliosis: a teaching method. allowance / NV. Solovey [and others]. - Minsk: BSMU, L18 2015. 31 р. (In Russ.)].
5. [Lyme disease in adults: a clinical guidelines / I.V. Shestakova [etc]. – 2014. – 76 р. (In Russ.)].
6. [Tick-borne viral encephalitis at adults: аclinical guidelines/ I.V. Shestakova [etc.]. – 2014. – 85 р. (In Russ.)].
7. [Nizov AA. Fever of not clear genesis: an educational and methodical grant for students of medical faculty / AA. Nizov, NS. Asfandiyarova, EI. Koldynskaya; SEI VPO to RYAZGM of the Russian Ministry of Health. – Ryazan: RIO to RyazGM, 2015.–137 p. (In Russ.)].
8. Gülizar Demirok, Mehmet Fatih Kocamaz, Berati Hasanreisoğlu. Unilateral sequential papillophlebitisand central retinal artery occlusion in a young healthy patient. Indian J Ophthalmol. 2015 Dec;63(12):921-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784082/#!po=8.33333 accessed September 27, 2017.
9. Irfan Ansari, MD; Brian Crichlow, MD; Kammi B. Gunton, MD A Child With Venous Sinus Thrombosis With Initial Examination Findings of Pseudotumor Syndrome. Arch Ophthalmol. 2002 Jun;120(6):867. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/270833 accessed September 24, 2017.
10. Katarina Blažina, Vladimir Miletić, Maja Relja, Danira Bažadona. Cerebralsinuvenous thrombosis: a rare complication of Lyme neuroborreliosis. Wiener klinische Wochenschrift. January 2015; 127(Issue1–2):65-7. https://link.springer.com/article/10.1007%2Fs00508-014-0622-5 accessed Oktober 14, 2017.
11. Michael Adamaszek, Alexander Heinrich, Andreas Rang, SönkeLangner, Alexander V. Khaw. Cerebral sinuvenous thrombosis associated with Lyme neuroborreliosis. J Neurology. March 2010;257 (Issue 3):481-3. https://link.springer.com/article/10.1007%2Fs00415-009-5397-7 accessed September 22, 2017.
12. Juan Carlos Garcia-Pagan, Elisabetta Buscarini and etc. Клинические рекомендации EASL: заболевания сосудов печени. J Hepatology. July2015. Пропуск тома, №, стр. http://www.easl.eu/medias/ cpg/pdf_files/Vascular_diseases_of_the_liver_RU.pdf accessed January 25, 2018.
13. [Petukhov VA. Endothelial dysfunction: current state of the matter (based on the materials of a scientific symposium). Consilium Medicum. Surgery. 2008;1:3-11 (In Russ.)]. http://cnmt.tomsk.ru/articles/antistax.pdf accessed December 15 2017.
14. [MelnikovaYuS, Makarova TP. Endothelial dysfunction as the central link of the pathogenesis of chronic diseases. Kazan Medical Journal. 2015;96(4):659-65. (In Russ.)]. http://journals.eco-vector.com/kazanmedj/issue/view/126 accessed December 21 2017.
15. Andrew Moore, Christina Nelson, Claudia Molins, Paul Mead, Martin Schriefer Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease. United States Emerging Infectious Diseases. July 2016;22(7). [www.cdc.gov/eid]

Авторы

Е.В. Резник 1,3, М.П. Прушковская 2, Е.Д. Преснова 1, Н.А. Новикова 2, Р.А. Иващенко 3, Е.И. Дедов 1,2, А.Э. Никитин 2, И.Г. Никитин 1

1 Кафедра госпитальной терапии №2 лечебного факультета ФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, Москва, Россия;
2 Центральная клиническая больница Российской академии наук, Москва, Россия
3 ГБУЗ «Городская клиническая больница имени В.М. Буянова» Департамента здравоохранения города Москвы, Москва, Россия

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E.V. Reznik 1,3, M.P. Prushkovskaya 2, E.D. Presnova 1, N.A. Novikova 2, R.A. Ivaschenko 3, E.I. Dedov 1,2, A.E. Nikitin 2, I.G. Nikitin 1

1 N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia;
2 Central Clinical Hospital, Moscow, Russia;
3 V.M. Buyanov City Clinical Hospital, Moscow, Russia

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