ドレナージ治療中に多発性脳膿ようを続発した急性膿胸の一例

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  • A case with acute empyema followed by multiple brain abscesses during tube drainage.

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A 60-year-old man was admitted to our hospital with chest pain and fever. The chest roentgenogram revealed left-sided pleural effusion and suggested pulmonary empyema. He was treated with intravenous administration of cefozopran hydrochloride, tube drainage and deterging with povidone iodine. After three weeks the improvement of these symptoms allowed cessation of antibiotics. Tube drainage and deterging were continued to decrease the remaining space of the empyema cavity. But seven weeks after admission he developed multiple brain abscesses with headache, epilepsy and consciousness disturbance. Methicillin-resistant staphylococcus aureus (MRSA) was detected in both sputum and impetigo under the drain fixing tape. Under the diagnosis of acute MRSA empyema and resultant brain abscess, vancomycin hydrochloride was administered intravenously. Then he recovered from epilepsy with improvement of the brain abscesses. And the disappearance empyema cavity made it possible to remove the thoracic drain. Careful treatment is necessary for empyema because of the high possibility of microbial substitution including MRSA infection.

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