Kobayashi Yoshiki, Yasuba Hirotaka, Yamashita Kenzo, Kita Hideo, Chiba Wataru, Hitomi Shigeki
Department of Respiratory Medicine, Takatsuki Red Cross Hospital.
Nihon Kokyuki Gakkai Zasshi. 2005 Mar;43(3):160-4.
A 52-year-old man was given a diagnosis of type 2 diabetes mellitus at age 39. At age 46, he stopped taking medication. Two weeks after burning his legs at low temperature, he fell, using his right arm to protect his legs. The next day, he complained of pain and slight swelling from his right shoulder to his anterior chest and came to our hospital. At that time, a plain computed tomography scan suggested gasogenic bacterial infection and we discussed the indications for debridment. Although his widespread inflammation required extensive treatment including thoracostomy, we abandoned surgical treatment and administered several antibiotics in appropriate combination because of his severe condition. After admission, the mass grew rapidly and it was diagnosed as necrotizing fasciitis based on percutaneous needle biopsy and clinical findings. Although both inflammatory reactions and mass size tended to improve, he had repeated recurrence of pain and swelling in his right anterior chest. When he had a second recurrence, he received additional short-term steroid therapy. Afterwards he had no further recurrence. In this case, early clinical diagnosis, using broad-spectrum antibiotics prior to definite diagnosis, and additional short-term steroid therapy at the time of the recurrence were effective.
一名52岁男性在39岁时被诊断为2型糖尿病。46岁时，他停止服药。在腿部被低温烫伤两周后，他摔倒，用右臂保护腿部。第二天，他主诉从右肩到前胸疼痛且略有肿胀，遂来我院就诊。当时，普通计算机断层扫描提示产气性细菌感染，我们讨论了清创的指征。尽管他广泛的炎症需要包括开胸手术在内的广泛治疗，但由于他病情严重，我们放弃了手术治疗，联合使用了几种抗生素。入院后，肿块迅速增大，根据经皮针吸活检和临床检查结果诊断为坏死性筋膜炎。尽管炎症反应和肿块大小都有改善的趋势，但他右前胸反复出现疼痛和肿胀。第二次复发时，他接受了额外的短期类固醇治疗。此后他未再复发。在这种情况下，早期临床诊断、在明确诊断前使用广谱抗生素以及复发时额外的短期类固醇治疗是有效的。
