頸部感染巣より発症した劇症型A群溶連菌感染症の1例 [in Japanese] A Case of Toxic Shock-like Syndrome Affecting the Neck [in Japanese]
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頸部感染巣より発症した劇症型A群溶連菌感染症(Toxic Shock-like Syndrome, TSLS)を経験した.症例は40歳男性で頸部の発赤,下痢,嘔吐で受診した.初診時よりショック状態であり,人工呼吸器管理や昇圧剤,ガンマグロブリン製剤,PAPM/BPとCLDMの投与,エンドトキシン吸着療法や持続的血液濾過透析を用いて全身状態は改善した.頸部症状もいったん軽快傾向を認めたが再び増悪し,頸部外切開を行い治癒した.TSLSでは内科的治療をまず優先的に行い,外科的治療については今後も検討する必要があると考えられた.
Toxic shock-like syndrome (TSLS) is a form of rapidly progressing septic shock that can lead to multiple organ failure and has a high mortality rate of 30%. We report a rare case of TSLS affecting the head and neck. A 40-year-old man complained of redness and swelling of the neck with vomiting and diarrhea. His blood pressure dropped, and multiple organ failure occurred.<br>Streptcoccus pyogenes, Group A, was identified in a blood culture, and he was diagnosed as having TSLS. He was treated with high-dose carbapenem, clindamysin, and gamma globulin. Continuous hemodiafiltration (CHDF) and PMX-DHP was applied to prevent sepsis and multiple organ failure. Debridement of the neck was performed on day 16. He recovered gradually and was discharged from hospital on day 45. A total resection is required to treat TSLS, but such a procedure is difficult to perform in the head and neck region. Our case improved without resection but after debridement and general control.<br>TSLS should be first treated by medication and then by surgery, consisting of either debridement or resection.
- Nippon Jibiinkoka Gakkai Kaiho
Nippon Jibiinkoka Gakkai Kaiho 109(9), 703-706, 2006-09-20
The Oto-Rhino-Laryngological Society of Japan, Inc.