劇症型A群溶連菌感染症(TSLS)を呈した骨盤腹膜炎の1例  [in Japanese] A Case Report of Sever Group A Streptococcal Infections Associated with A Toxic Shock-like Syndrome which Caused by Pelvic Peritonitis  [in Japanese]

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Author(s)

    • 久田 将之 HISADA Masayuki
    • 東京医科大学病院消化器小児外科 Tokyo-medical University Department of Gastroenterological and Pediatric Surgery
    • 石崎 哲央 ISHIZAKI Tetsuo
    • 東京医科大学病院消化器小児外科 Tokyo-medical University Department of Gastroenterological and Pediatric Surgery
    • 青木 達哉 AOKI Tatsuya
    • 東京医科大学病院消化器小児外科 Tokyo-medical University Department of Gastroenterological and Pediatric Surgery

Abstract

症例は35歳女性.主訴は発熱および腹痛.整形外科にて手術予定のため入院中,突然に38度以上の発熱認め徐々に下腹部痛と全身状態悪化を認めた.体温38.5℃,血圧82/44mmhg,下腹部に限局する反跳痛伴う強い圧痛を認めた.検査所見では血小板7.7万個/mm<sup>3</sup>,CRP25.8 mg/dlと著名な炎症反応を認め,骨盤腹膜炎によるDICショックの治療を先行した.治療開始48時間後,ショック状態から回復したが腹痛と発熱を認め,膣培養から<i>S.pyogenes</i>を検出された.また,腹部超音波およびMRIにて腹水の増大を認めたため腹腔ドレナージを施行した.その後,第98病日にて軽快退院となった.今回われわれは,急激に進行するA群溶連菌感染症に対しDICの治療を先行し,ショック状態からの離脱後,A群溶連菌による骨盤腹膜炎に対し腹腔穿刺によるドレナージを行い救命しえたため若干の文献的考察を加え報告する.

The case is a 35-year-old woman. Her main complaint is scarlet fever and abdominal pain. She suddenly accepted fever more than 38.5 degrees and lower abdominal pain. She had rebound tenderness at lower abdomen and low blood pressure, as 82/44mmhg. The laboratory findings showed severe infections as platelet 77,000/mm3, CRP25.8mg/dl. DIC shock due to the pelvic peritonitis was diagnosed and we started treatment for the DIC. And then patient recovered from a shock state, but,still had abdominal pain and fever. on the other hand, S.pyogenes was detected from vagina culture. 48 hours later, we performed abdominal cavity drainage because we recognized increase of the ascites by an abdominal supersonic wave and MRI.she could left hospital after 98days. We succeeded in treatment of pelvic peritonitis caused by the A group hemolytic streptococcus using abdominal puncture drainage, after recovering from DIC shock caused by severe A group hemolytic streptococcus infections.

Journal

  • Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

    Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 37(4), 869-875, 2012-08-30

    Japanese College of Surgeons

References:  47

Codes

  • NII Article ID (NAID)
    10031033697
  • NII NACSIS-CAT ID (NCID)
    AN00002502
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    03857883
  • Data Source
    CJP  J-STAGE 
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