Akamine Morikazu, Miyagi Kazuya, Uchihara Teruhito, Azuma Masato, Yara Satomi, Higa Futoshi, Haranaga Shusaku, Tateyama Masao, Matsuzaki Akiko, Nakayama Takashi, Fujita Jiro
Department of Medicine and Therapeutics, Control and Prevention of Infectious Diseases, University of the Ryukyus, Okinawa.
Intern Med. 2008;47(6):553-6. doi: 10.2169/internalmedicine.47.0651. Epub 2008 Mar 17.
An 85-year-old man patient was admitted to the hospital complaining of fever and bilateral leg pain with swelling and erythema. A laboratory investigation revealed leukocytopenia, thus suggesting sepsis. Gram negative rods were detected in the specimen from the affected skin and empiric antibacterial therapy was initiated. The following day, his symptoms worsened and Pseudomonas aeruginosa was isolated from the blood culture and the skin specimen. Magnetic resonance imaging (MRI) did not show the typical characteristics of necrotizing fasciitis. In spite of intensive medical treatment, the patient's condition became critical, and on day 10 after admission, he died of multiple organ failure. An autopsy revealed necrotizing fasciitis due to P. aeruginosa. This is a rare case and its clinical presentation was atypical. The clinical diagnosis of this infection may be difficult, and therefore such cases warrant the careful attention of physicians.
一名85岁男性患者因发热、双侧腿痛伴肿胀和红斑入院。实验室检查显示白细胞减少，提示败血症。在受影响皮肤的标本中检测到革兰氏阴性杆菌，并开始进行经验性抗菌治疗。第二天，他的症状恶化，血液培养和皮肤标本中分离出铜绿假单胞菌。磁共振成像（MRI）未显示坏死性筋膜炎的典型特征。尽管进行了强化治疗，患者的病情仍变得危急，入院第10天，他死于多器官功能衰竭。尸检显示为铜绿假单胞菌所致的坏死性筋膜炎。这是一例罕见病例，其临床表现不典型。这种感染的临床诊断可能困难，因此这类病例值得医生密切关注。
