Kömüs Nuray, Kilinç Oğuz, Güneş Jini, Soytürk Müjde
Department of Chest Disease, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
Tuberk Toraks. 2005;53(4):397-400.
65 years old female was admitted to hospital with fever, purulent sputum and dyspnea. The patient has hepatic cirrhosis secondary to autoimmune hepatitis and hepatocellular carcinoma. Immunosuppressive treatment is used for autoimmune hepatitis. In physical examination matute and diminished respiratory sounds were determined at right hemithorax. Ascitis was determined in abdominal examination. Chest X-ray showed pleural effusion in right hemithorax. Serohemorrhagic fluid was aspirated by thoraco-synthesis. Pleural fluid pH was 6.9 and had an exudative nature. The patient was the diagnosed as empyema. Right tube thoracostomy was performed and sulbactam-ampicillin 6 g/day therapy was started. In patient's ascite fluid no bacteria and leucocytes was seen. Salmonella typhi was isolated from pleural fluid. No microorganisms were isolated from ascite fluid, urine and stool culture. Klebsiella pneumoniae is isolated in patient's hemoculture. Clinical improving was detected. Chest X-ray showed total regression of pleural fluid and the tube thoracostomy removed. We presented this case because of rarely seen microorganism (S. typhi) in immunocompromised patients a cause of pleural empyema which is frequently seen gastrointestinal infections.
一名65岁女性因发热、脓性痰和呼吸困难入院。该患者患有自身免疫性肝炎继发的肝硬化和肝细胞癌，正在接受自身免疫性肝炎的免疫抑制治疗。体格检查发现右半胸呼吸音减弱。腹部检查发现腹水。胸部X线显示右半胸胸腔积液。通过胸腔穿刺抽出了血清血性液体。胸腔积液pH值为6.9，具有渗出液性质。该患者被诊断为脓胸。进行了右胸腔闭式引流术，并开始使用舒巴坦-氨苄西林6克/天进行治疗。在患者的腹水液中未发现细菌和白细胞。从胸腔积液中分离出伤寒沙门氏菌。腹水液、尿液和粪便培养均未分离出微生物。血培养中分离出肺炎克雷伯菌。检测到临床症状改善。胸部X线显示胸腔积液完全消退，胸腔闭式引流管已拔除。我们报告此病例是因为在免疫功能低下患者中罕见的微生物（伤寒沙门氏菌）是胸腔脓胸的病因，而胸腔脓胸在胃肠道感染中较为常见。
