インフルエンザ罹患後に発症した喉頭蓋膿瘍の3例  [in Japanese] Acute Epiglottitis as a Fetal Complication in Patients Affected with Influenza  [in Japanese]

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Abstract

インフルエンザによる死因として肺炎,脳炎,心筋炎などの合併に加え原因不明の心肺停止が報告されている。今回われわれはインフルエンザを契機に発症したと考えられる喉頭蓋膿瘍の3例を経験した。症例1 (45歳,男性) はインフルエンザB型の診断の後,自宅安静を指示されたが,その数時間後には呼吸困難感が出現し,まもなく窒息による心肺停止に至った。症例2 (62歳,男性) はインフルエンザA型の診断のもとノイラミニダーゼ阻害薬を処方されたが,数時間後には呼吸困難感が出現した。症例3 (53歳,女性) はインフルエンザA型の診断のもとラニナビルの処方をうけ,咽頭痛は一旦軽快したものの,4日後に呼吸困難感が出現した。いずれの症例も喉頭ファイバースコープ検査にて腫脹した喉頭蓋による高度の気道狭窄を認めた。インフルエンザに関連した原因不明の心肺停止の原因の一部に本症例のような気道狭窄性病変が含まれると考えられた。インフルエンザ症例の診察の際には気道狭窄に伴う症状,所見がないか確認すること,また,自宅安静を指示する際には,気道狭窄症状出現時には早急に医療機関を受診するよう指示することが肝要と考えられた。

It has been reported that fatal complications associated with influenza include unexpected cardiopulmonary arrest as well as pneumonia, encephalitis and myocarditis. Here we report three cases with life-threatening epiglottic abscess that developed shortly after diagnosis of influenza. Case 1: A 45-year-old male visited a primary-care physician with a sore throat and was diagnosed with influenza B using a throat swab. A few hours later, breathing became difficult and he called for an ambulance. An emergency medical team found him in cardiopulmonary arrest at home. Case 2: A 62-year-old male with fever and dysphagia was diagnosed as influenza A and administered the neuraminidase inhibitor zanamivir. Breathing difficulties appeared several hours later, during the night. Case 3: A 53-year-old female with a sore throat was diagnosed as influenza B and administered the inhaled neuraminidase inhibitor laninamivir octanoate. The sore throat was resolved after several days but dyspnea reappeared four days after the diagnosis of influenza. In all three cases, flexible fiberscopy revealed a swollen epiglottis with an abscess that had almost completely closed the upper respiratory tract. We believe that acute epiglottitis can be a fatal complication in patients infected with influenza virus. It is recommended to assess the presence or absence of signs and symptoms of airway constriction in physical examination of patients with influenza. It is also important to give instruction to patients to return to the clinic if respiratory distress develops.

Journal

  • Nihon Kikan Shokudoka Gakkai Kaiho

    Nihon Kikan Shokudoka Gakkai Kaiho 65(6), 468-473, 2014

    The Japan Broncho-esophagological Society

Codes

  • NII Article ID (NAID)
    130004724632
  • NII NACSIS-CAT ID (NCID)
    AN00187474
  • Text Lang
    JPN
  • ISSN
    0029-0645
  • NDL Article ID
    025966868
  • NDL Call No.
    Z19-214
  • Data Source
    NDL  J-STAGE 
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