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多発内分泌腫瘍Ⅰ型患者に合併したVibrio vulnificus 感染症の1救命例

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概要 A 35-year-old female with malabsorption syndrome who underwent a pancreatoduodenectomy for multiple endocrine adenomatosis 13 years prior was admitted to our hospital with diarrhea, general fatigue, h...igh fever, and eruption in the lower legs. The patient had consumed raw shrimp a few days before onset and presented systemic inflammatory response syndrome at the time of hospitalization. Vibrio vulnificus was isolated from a blood culture performed before admission to the intensive care unit. We excised necrotizing tissue in the legs after improvement of her general condition. During the treatment process, glucose, catecholamine, and appropriate antibiotics were administered for hypoglycemia, hypotension, and high fever, respectively. The patient was discharged 107 days after contracting the disease. Of 18 septic patients with V. vulnificus infection admitted to our hospital,this was the first to develop septicemia in the absence of a previous liver dysfunction. In order to prevent this type of fatal infection, public education for immuno-compromised individuals as well as those with liver disease is essential. For early diagnosis and appropriate treatment, more effective strategies are required, such as the establishment of a network system where family physicians and emergency hospital staff could discuss information regarding high-risk patients.
多発性内分泌腫瘍術後の吸収不良症候群の35歳女性が,下痢,全身倦怠感,発熱及び両下肢の疼痛を伴う皮膚病変のため当院へ入院となった.患者は発症前に海老を生食していた.入院時はSystemicInflammatory Response Syndromeの状態で,血液培養よりVibrio vulnificus が同定されICU 入室となった.下肢の壊死組織部分に関しては,全身状態の改善を待ちデブリドマンを施行した.経過中に,低血糖発作や血圧低下,発熱を起こしたが,ブドウ糖静注やカテコラミン投与,抗生剤の変更等で対処し,入院107日目に軽快退院となった.当院でのVibrio vulnificus 感染症患者は,本症例以外はすべて明らかな肝機能障害を認めていたが,今後は免疫不全や低栄養状態の患者など,易感染性の状態である患者に対しても,本症の予防に関する啓発活動が重要であり周辺医療機関との相互の情報交換が必要である.
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登録日 2009.04.22
更新日 2017.07.31