内容紹介
Successful Prophylactic Minocycline Treatment for Recurrent Helicobacter Cinaedi Sepsis during Chemotherapy in a Patient with Follicular Lymphoma
Summary
A 63-year-old man with follicular lymphoma was administered standard R-CHOP chemotherapy. Six days after the second course of chemotherapy, the patient developed fever and chills. Blood cultures yielded rod-shaped gram-negative bacteria, but no further identification was obtained. High fever and chills returned on the fifth and sixth days after the third and fourth courses of R-CHOP, respectively. These blood cultures were also positive. Since we detected spiral-shaped gram-negative rods, we performed a prolonged culture during the febrile period after the fourth course of R-CHOP. This revealed the formation of characteristic film-like colonies, and Helicobacter cinaedi(H. cinaedi)bacteria was identified. After final identification, the patient was administered prophylactic minocycline treatment. Subsequent blood cultures were negative, fever did not recur, and we were able to complete 6 courses of R-CHOP. Although H. cinaedi has been reported to be a cause of sepsis in immunocompromised patients, standard correlation has not been established. Our case suggests that H. cinaedi should be considered when recurrent fever is observed after chemotherapy. Prophylactic antibiotic treatment with minocycline may prevent sepsis, as observed in our case.
要旨
症例は63歳,男性。濾胞性リンパ腫に対し施行した化学療法後に発熱を繰り返し認めた。発熱は広域抗菌薬投与で速やかに解熱した。血液培養ではその度ごとに好気性ボトルからグラム陰性桿菌が検出されたが,菌の同定に至らなかった。4コース後の血液培養で螺旋状のグラム陰性桿菌が認められ,培養を延長したところフィルム状のコロニーを形成したことからHelicobacter cinaedi(H. cinaedi)の可能性を強く疑った。本邦でH. cinaediの感受性が高いと報告があるminocycline(MINO)内服を併用したところ,以降の発熱および血液培養による菌の検出は認めず,R-CHOP療法6コースを完遂できた。H. cinaediは,化学療法を繰り返すたびに感染症を繰り返すことが知られているが,治療法は確立されていない。本症例では,あらかじめMINOを投与することでH. cinaedi敗血症の発症が予防され,化学療法を完遂することができたと考えられる。
目次
Summary
A 63-year-old man with follicular lymphoma was administered standard R-CHOP chemotherapy. Six days after the second course of chemotherapy, the patient developed fever and chills. Blood cultures yielded rod-shaped gram-negative bacteria, but no further identification was obtained. High fever and chills returned on the fifth and sixth days after the third and fourth courses of R-CHOP, respectively. These blood cultures were also positive. Since we detected spiral-shaped gram-negative rods, we performed a prolonged culture during the febrile period after the fourth course of R-CHOP. This revealed the formation of characteristic film-like colonies, and Helicobacter cinaedi(H. cinaedi)bacteria was identified. After final identification, the patient was administered prophylactic minocycline treatment. Subsequent blood cultures were negative, fever did not recur, and we were able to complete 6 courses of R-CHOP. Although H. cinaedi has been reported to be a cause of sepsis in immunocompromised patients, standard correlation has not been established. Our case suggests that H. cinaedi should be considered when recurrent fever is observed after chemotherapy. Prophylactic antibiotic treatment with minocycline may prevent sepsis, as observed in our case.
要旨
症例は63歳,男性。濾胞性リンパ腫に対し施行した化学療法後に発熱を繰り返し認めた。発熱は広域抗菌薬投与で速やかに解熱した。血液培養ではその度ごとに好気性ボトルからグラム陰性桿菌が検出されたが,菌の同定に至らなかった。4コース後の血液培養で螺旋状のグラム陰性桿菌が認められ,培養を延長したところフィルム状のコロニーを形成したことからHelicobacter cinaedi(H. cinaedi)の可能性を強く疑った。本邦でH. cinaediの感受性が高いと報告があるminocycline(MINO)内服を併用したところ,以降の発熱および血液培養による菌の検出は認めず,R-CHOP療法6コースを完遂できた。H. cinaediは,化学療法を繰り返すたびに感染症を繰り返すことが知られているが,治療法は確立されていない。本症例では,あらかじめMINOを投与することでH. cinaedi敗血症の発症が予防され,化学療法を完遂することができたと考えられる。