Suzuki Takashi, Takemura Hiroshi, Shida Kenji, Higuchi Hitomi, Ohtsuka Naoki, Masuda Yutaka
Department of Anesthesiology, School of Medicine, Showa University, Tokyo 142-8666.
Masui. 2002 Mar;51(3):293-5.
A 79-year-old man with herpes zoster was referred to our hospital for pain control. He was a survivor of the atomic bombing of Hiroshima, and had a history of cerebral infarction and hypertension. A cervical epidural catheter was placed for continuous analgesic infusion. After 20 days of catheterization, he gradually developed a high fever and confusion, and complained of nausea and headaches. An urgent blood examination revealed a white blood cell count of 15,200 mm-3 and a C-reactive protein of 32.4 mg.dl-1. The catheter was removed and antibiotic therapy was started. Repeated magnetic resonance imaging could not confirm epidural abscess formation. The bacterial culture of the cerebrospinal fluid was negative, but the cultures of the blood, the catheter tip, and the nasal cavity swab were positive for methicillin-resistant Staphylococcus aureus. Although intravenous vancomycin was administered, systemic inflammation persisted. The patient consecutively suffered varied disorders such as acute renal failure, disseminated intravascular coagulation, and gastrointestinal bleeding. Although symptomatic treatment had been prolonging his life, 58 days after the catheter removal, the patient suddenly developed cerebellopontine infarction, which made mechanical ventilation necessary. He remained unconscious until his death 117 days after the catheter removal. We discussed the possible pathogenetic mechanisms of the present case.
一名79岁的带状疱疹男性患者因疼痛控制被转诊至我院。他是广岛原子弹爆炸的幸存者，有脑梗死和高血压病史。置入颈段硬膜外导管用于持续镇痛输注。置管20天后，他逐渐出现高热和意识模糊，并伴有恶心和头痛。紧急血液检查显示白细胞计数为15200/mm³，C反应蛋白为32.4mg/dl⁻¹。导管被拔除并开始抗生素治疗。重复磁共振成像未能证实硬膜外脓肿形成。脑脊液细菌培养为阴性，但血液、导管尖端和鼻腔拭子培养对耐甲氧西林金黄色葡萄球菌呈阳性。尽管给予了静脉万古霉素治疗，但全身炎症仍持续存在。患者相继出现各种病症，如急性肾衰竭、弥散性血管内凝血和胃肠道出血。尽管对症治疗延长了他的生命，但在导管拔除58天后，患者突然发生小脑桥脑梗死，需要机械通气。直到导管拔除117天后死亡，他一直昏迷。我们讨论了本病例可能的发病机制。
