内容紹介
Summary
A 64-year-old woman was diagnosed with hereditary spherocytosis 30 years ago and underwent splenectomy. She presented to the hospital with lower abdominal pain and was diagnosed with sigmoid colon cancer(cT3N3M1[LYM], H1, Stage Ⅳ)for which sigmoidectomy was performed. On the 7th postoperative day, a fever of 40℃ and an inflammatory reaction were observed. She developed a consciousness disorder the next day, and her condition rapidly deteriorated along with the development of septic shock and disseminated intravascular coagulation(DIC). With the aid of a ventilator, immediate treatment for DIC was started, but reversion of septic shock and DIC was not possible, and the patient died of multiple organ dysfunction on the 17th postoperative day. Computed tomography and urinalysis performed during the course of treatment showed no infected lesion, but Citrobacter spp. was detected thrice in venous blood culture. Hence, the patient was diagnosed as a case of Citrobacter overwhelming post splenectomy infection(OPSI). To our knowledge, this is the first report of Citrobacter spp. infection following an abrupt course of OPSI.
要旨 症例は64歳,女性。遺伝性球状赤血球症で30年前に脾臓摘出の既往がある。今回,S状結腸癌[cT3N3M1(LYM),H1,Stage Ⅳ]の診断で,開腹S状結腸切除術を施行した。術後7日目に40℃の発熱と炎症反応の高値を認め,翌日に意識障害が出現し急速に敗血症性ショック・DICに至った。人工呼吸器管理の下,敗血症性ショック・DICの治療を行ったが離脱できず,術後17日目に多臓器不全により死亡した。経過中に施行したCT検査・尿検査では感染巣は見当たらず,静脈血培養よりCitrobacter spp. が三度検出されたことにより,Citrobacter spp. による脾臓摘出後重症感染症(overwhelming post splenectomy infection: OPSI)と診断した。Citrobacter spp. によるOPSIで急激な経過をたどった報告は,われわれが検索し得た範囲で本症例が第1例目となる。若干の文献的考察を加えて報告する。
目次
A 64-year-old woman was diagnosed with hereditary spherocytosis 30 years ago and underwent splenectomy. She presented to the hospital with lower abdominal pain and was diagnosed with sigmoid colon cancer(cT3N3M1[LYM], H1, Stage Ⅳ)for which sigmoidectomy was performed. On the 7th postoperative day, a fever of 40℃ and an inflammatory reaction were observed. She developed a consciousness disorder the next day, and her condition rapidly deteriorated along with the development of septic shock and disseminated intravascular coagulation(DIC). With the aid of a ventilator, immediate treatment for DIC was started, but reversion of septic shock and DIC was not possible, and the patient died of multiple organ dysfunction on the 17th postoperative day. Computed tomography and urinalysis performed during the course of treatment showed no infected lesion, but Citrobacter spp. was detected thrice in venous blood culture. Hence, the patient was diagnosed as a case of Citrobacter overwhelming post splenectomy infection(OPSI). To our knowledge, this is the first report of Citrobacter spp. infection following an abrupt course of OPSI.
要旨 症例は64歳,女性。遺伝性球状赤血球症で30年前に脾臓摘出の既往がある。今回,S状結腸癌[cT3N3M1(LYM),H1,Stage Ⅳ]の診断で,開腹S状結腸切除術を施行した。術後7日目に40℃の発熱と炎症反応の高値を認め,翌日に意識障害が出現し急速に敗血症性ショック・DICに至った。人工呼吸器管理の下,敗血症性ショック・DICの治療を行ったが離脱できず,術後17日目に多臓器不全により死亡した。経過中に施行したCT検査・尿検査では感染巣は見当たらず,静脈血培養よりCitrobacter spp. が三度検出されたことにより,Citrobacter spp. による脾臓摘出後重症感染症(overwhelming post splenectomy infection: OPSI)と診断した。Citrobacter spp. によるOPSIで急激な経過をたどった報告は,われわれが検索し得た範囲で本症例が第1例目となる。若干の文献的考察を加えて報告する。