Cengiz A Bülent, Kanra Güler, Celik Tolga, Cömert Bariş, Devrim Ilker, Ozen Metehan, Kara Ateş
Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2005 Oct-Dec;47(4):393-6.
We report the case of a five-year-old healthy boy who was admitted with abscess and soft tissue infection between the left wrist and the distal end of the forearm. Postero-anterior X-ray examination of the forearm showed a transverse line on the radius; however, further comparative radiographic examinations of the forearm were not compatible with fracture. Enterobacter cloacae was identified in the pus culture and initial intravenous empiric treatment with sulbactam-ampicillin was continued. Although the microorganism was susceptible to the empiric antimicrobial agent, at the eighth day of the treatment, inflammatory drainage was still present so further evaluations were performed. Ultrasonography of the forearm and wrist revealed only collection; magnetic resonance imaging showed a foreign body on the anterior distal section of the left forearm. The patient underwent operation and a 22 mm wooden foreign body was removed. Detailed history after removing a tree branch particle revealed that the boy had recently fallen from a tree causing an abrasion over the left wrist. The postoperative course was uneventful and clinical response was excellent in two days. In view of this case report, we would like to emphasize the importance of medical history and imaging studies in cases of cellulitis that do not respond to appropriate antimicrobial therapy. Another point to be kept in mind is that Enterobacter cloacae, which is very rarely reported as a causative agent for cellulitis, could be the etiological agent in cases after plant thorn injuries.
我们报告了一例5岁健康男孩的病例，该男孩因左腕与前臂远端之间的脓肿和软组织感染入院。前臂正位X线检查显示桡骨上有一条横线；然而，进一步的前臂对比影像学检查与骨折不符。脓液培养中鉴定出阴沟肠杆菌，并继续使用舒巴坦-氨苄西林进行初始静脉经验性治疗。尽管该微生物对经验性抗菌药物敏感，但在治疗的第8天，仍有炎性引流，因此进行了进一步评估。前臂和手腕的超声检查仅显示有积液；磁共振成像显示左前臂远端前部有一个异物。患者接受了手术，取出了一个22毫米的木质异物。在取出树枝颗粒后的详细病史显示，该男孩最近从树上跌落，导致左手腕擦伤。术后过程顺利，两天内临床反应良好。鉴于此病例报告，我们想强调病史和影像学检查在对适当抗菌治疗无反应的蜂窝织炎病例中的重要性。另一点需要记住的是，阴沟肠杆菌作为蜂窝织炎的病原体很少被报道，但在植物刺伤后的病例中可能是病原体。
