重型再生障碍性贫血合并蜡样芽孢杆菌多发感染1例

doi:10.3969/j.issn.1674-8115.2025.08.016

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (8): 1074-1078.doi: 10.3969/j.issn.1674-8115.2025.08.016

• 病例报告 • 上一篇

重型再生障碍性贫血合并蜡样芽孢杆菌多发感染1例

周慧茹, 张丽琴(), 张晓星, 孙志江

甘肃省人民医院重症医学科二病区，兰州 730000

收稿日期:2025-03-06 接受日期:2025-04-28 出版日期:2025-08-28 发布日期:2025-08-18
通讯作者: 张丽琴，副主任医师，硕士；电子信箱：zhangliqin1984@163.com。
基金资助:
甘肃省医学检验临床医学研究中心项目(21JR7RA676);兰州市科技计划项目(2023-2-100);甘肃省人民医院科研基金(24GSSYB-9)

Case report of severe aplastic anemia complicated by multiple Bacillus cereus infections

ZHOU Huiru, ZHANG Liqin(), ZHANG Xiaoxing, SUN Zhijiang

Department of Intensive Care Unit 2, Gansu Provincial Hospital, Lanzhou 730000, China

Received:2025-03-06 Accepted:2025-04-28 Online:2025-08-28 Published:2025-08-18
Contact: ZHANG Liqin, E-mail: zhangliqin1984@163.com.
Supported by:
Gansu Medical Laboratory Clinical Medicine Research Center(21JR7RA676);Lanzhou City Science and Technology Plan Projects(2023-2-100);Gansu Provincial Hospital Research Fund(24GSSYB-9)

摘要/Abstract

摘要：

重型再生障碍性贫血患者本身存在粒细胞减少，在接受免疫抑制治疗后，更易发生感染，常合并多系统并发症。蜡样芽孢杆菌（Bacillus cereus，B. cereus）分布广泛，可在健康人群定植，是典型的机会性致病菌，其感染途径多样。粒细胞缺乏是多种血液系统疾病的常见表现之一，存在粒细胞缺乏的血液系统疾病患者更容易感染B. cereus。该文报道1例重型再生障碍性贫血患者，在免疫抑制治疗后的粒细胞缺乏期，发生B. cereus菌血症同时发生多处脓肿的病例。重型再生障碍性贫血合并B. cereus菌血症伴多处脓肿的病例较为罕见。该文结合相关文献，深入分析诊疗过程，总结经验，以期提升此类患者的临床诊疗水平。

关键词: 再生障碍性贫血, 蜡样芽孢杆菌, 菌血症, 脓肿

Abstract:

Patients with severe aplastic anemia (SAA) often present with neutropenia, and are particularly susceptible to infections, especially following immunosuppressive therapy. Bacillus cereus is a ubiquitous, opportunistic pathogen capable of colonizing healthy individuals and causing infections through various routes. Neutropenia is a common feature in many hematologic disorders, placing affected patients at higher risk for Bacillus cereus infections. This report describes a rare case of Bacillus cereus bacteremia with multiple abscesses in a patient with SAA during the neutropenic phase following immunosuppressive therapy. Given the rarity of such presentations, relevant literature was reviewed and the diagnostic and treatment process was analyzed in detail, with the aim of providing clinical insights and improving the management of similar cases.

Key words: aplastic anemia, Bacillus cereus, bacteremia, abscess

中图分类号:

R556.5

周慧茹, 张丽琴, 张晓星, 孙志江. 重型再生障碍性贫血合并蜡样芽孢杆菌多发感染1例[J]. 上海交通大学学报（医学版）, 2025, 45(8): 1074-1078.

ZHOU Huiru, ZHANG Liqin, ZHANG Xiaoxing, SUN Zhijiang. Case report of severe aplastic anemia complicated by multiple Bacillus cereus infections[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(8): 1074-1078.

图/表 5

图1 骨髓细胞形态学检查（×1 000，瑞特染色）Note： Bone marrow hyperplasia was significantly reduced. The red blood cell is indicated by the red arrow, and the white blood cell is indicated by the blue arrow.

Fig 1 Morphological examination of bone marrow cells (×1 000, Wright staining)

图2 骨髓活检样本组织学观察（×400，苏木精-伊红染色）Note： The submitted specimen showed a markedly decreased number of granulocytic, erythroid, and megakaryocytic lineage cells.

Fig 2 Histological observation of bone marrow biopsy samples（×400, hematoxylin-eosin staining）

图3 病情进展前后CT影像学对比Note： A. Chest CT image obtained before B. cereus infection, showing no obvious infectious lesion in the region indicated by the red arrow. B. Chest CT image after B. cereus infection, demonstrating a distinct infectious lesion in the same region (red arrow). C. Abdominal CT image obtained before B. cereus infection, with no apparent infectious lesion in the region indicated by the red arrow. D. Abdominal CT image after B. cereus infection, showing a clearly visible infectious lesion in the corresponding area (red arrow).

Fig 3 Radiological comparison of CT images before and after disease progression

图4 头颅MRI图像Note： Head MRI scans at different levels demonstrate abnormal signal-occupying lesions in the right basal ganglia (A), bilateral parietal lobes parietal lobes (B), and the left frontal lobe (C), as indicated by red arrows.

Fig 4 MRI images of the head

表1 B. cereus 药敏结果

Tab 1 Drug susceptibility results of B. cereus

Antibiotic	Criteria		MIC/ (μg·mL^-1)	Result
Antibiotic	Sensitive/ (μg·mL^-1)	Resistant/(μg·mL^-1)	MIC/ (μg·mL^-1)	Result
Tetracycline	≤4	≥16	8	Mediated
Vancomycin	≤4	‒	1	Sensitive
Erythromycin	≤0.5	≥8	0.064	Sensitive
Meropenem	≤4	≥16	>32	Resistant
Gentamicin	≤4	≥16	0.19	Sensitive
Imipenem	≤4	≥16	>32	Resistant
Amikacin	≤16	≥64	1	Sensitive
Penicillin G	≤0.125	≥0.25	>32	Resistant

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重型再生障碍性贫血合并蜡样芽孢杆菌多发感染1例

Case report of severe aplastic anemia complicated by multiple Bacillus cereus infections

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[2]	张秋蕊, 陈虹, 周敏, 等. 以肝脾冷脓肿为首发症状的结核病一例报道[J]. , 2013, 33(4): 526-.