Kitamura Toshiro, Nakase Hajime, Iizuka Hidehiko
Department of Surgery, Yamanashi-Kouyo Hospital, Yamanashi-Japan.
J Nephrol. 2006 Sep-Oct;19(5):687-90.
A 66-year-old man with a two-year history of hepatitis C viral liver cirrhosis, was diagnosed as having ascending colon cancer. Right hemicolectomy was performed, and a drain was fed down to the anastomosis. On post-operative day (POD) 9, and methicillin-sensitive Staphylococcus aureus (MSSA) was isolated from both drains. After POD 12, relapsing persistent diarrhea with some blood occurred. On POD 20, the temperature increased to 39 degrees C, with symmetrical purpura and swelling in the femurs, and knee arthralgia developed. HSP was suspected. Clinical follow-up showed slight spontaneous reduction of diarrhea and purpura on POD 26. However, despite the negative drain culture, the high fever was maintained on POD 27. Therefore, intravenous steroid pulse therapy was performed. The purpura subsequently disappeared, except for a slight pigmentation and the temperature returned to normal. A renal biopsy was performed 26 days after the appearance of purpura. Pathological views demonstrated acute focal segmental glomerulonephritis-like nephropathy in addition to cirrhotic nephropathy with a membranoproliferative glomerulonephritis (MPGN)-like pattern and the mesangial proliferative glomerulonephritis type. We describe a case of Henoch-Schönlein purpura (HSP) after postoperative Staphylococcus aureus infection of the intra-abdominal drain with IgA nephropathy associated with hepatitis C virus liver cirrhosis.
一名66岁男性，有丙型肝炎病毒肝硬化病史两年，被诊断为升结肠癌。行右半结肠切除术，并在吻合口处放置引流管。术后第9天，两根引流管均分离出对甲氧西林敏感的金黄色葡萄球菌（MSSA）。术后第12天之后，出现反复持续腹泻并伴有少量便血。术后第20天，体温升至39摄氏度，双下肢出现对称性紫癜和肿胀，并出现膝关节疼痛。怀疑为过敏性紫癜（HSP）。临床随访显示，术后第26天腹泻和紫癜略有自行减轻。然而，尽管引流管培养结果为阴性，但术后第27天仍持续高热。因此，进行了静脉类固醇冲击治疗。随后紫癜消失，仅遗留轻微色素沉着，体温恢复正常。紫癜出现26天后进行了肾活检。病理检查显示，除了具有膜增生性肾小球肾炎（MPGN）样模式和系膜增生性肾小球肾炎类型的肝硬化性肾病外，还存在急性局灶节段性肾小球肾炎样肾病。我们报告一例腹部引流管术后金黄色葡萄球菌感染后并发过敏性紫癜（HSP）并伴有与丙型肝炎病毒肝硬化相关的IgA肾病的病例。
