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[源于妇科的坏死梭杆菌性脓毒性休克合并急性呼吸窘迫综合征:勒米尔综合征的一种变体]

[Septic shock Fusobacterium necrophorum from origin gynecological at complicated an acute respiratory distress syndrome: a variant of Lemierre's syndrome].

作者信息

Huynh-Moynot Sophie, Commandeur Diane, Danguy des Déserts Marc, Drouillard Isabelle, Leguen Patrick, Ould-Ahmed Mehdi

机构信息

Hopital d' instruction des armees Clermont-Tonnerre BCRM de Brest CC41, Federation d'anesthesie-reanimation et des urgences, Federation des Laboratoires, Brest, France.

出版信息

Ann Biol Clin (Paris). 2011 Mar-Apr;69(2):202-7. doi: 10.1684/abc.2011.0538.

Abstract

We report a case of a female patient of 47 years old who presents in a state of septic shock with acute insufficient respiratory complicated with syndrome of acute respiratory distress, together with a list of abdominal pain and polyarthralgia too. In her case of medical history, it is retained that she has had a intra-uterine device since 6 years without medical follow up. The initial thoraco-abdomino-pelvic scan shows a left ovarian vein thrombosis, as well as the opaqueness alveolus diffused interstitiel bilaterally and an aspect of ileitis. The IUD is taken off because of sudden occuring of purulent leucorrhoea. This results in a clinical and paraclinical improvement, whereas aminopenicillin was administered to the patient since 1 week. The microbiological blood test allows to put in evidence Fusobacterium necrophorum found in a blood culture and is sensitive to the amoxicilline-acide clavulanique and metronidazole. Isolation of this bacteria, classically found in Lemierre's syndrome, allowed to explain the multilfocalization of the symtoms and the list of pain. The whole concerns about a variant of Lemierre's syndrom: a state of septic shock secondary then caused by the anaerobic Gram negative bacilli, which is a commensal bacteria of the female genital tractus, complicated of septic emboli typical.

摘要

我们报告一例47岁女性患者,其以感染性休克状态就诊,伴有急性呼吸功能不全并并发急性呼吸窘迫综合征,同时还有腹痛和多关节痛症状。在她的病史中,自6年前起放置宫内节育器,但未进行医学随访。最初的胸腹部盆腔扫描显示左卵巢静脉血栓形成,以及双侧弥漫性间质肺泡不透明和回肠炎表现。由于突然出现脓性白带,取出了宫内节育器。这导致了临床和辅助检查方面的改善,而患者已接受氨基青霉素治疗1周。微生物血液检测发现血液培养中存在坏死梭杆菌,且对阿莫西林-克拉维酸和甲硝唑敏感。这种细菌的分离,通常在勒米尔综合征中发现,解释了症状的多灶性和疼痛症状。整个情况涉及勒米尔综合征的一种变体:继发于厌氧革兰氏阴性杆菌(女性生殖道共生菌)的感染性休克状态,并伴有典型的脓毒性栓子并发症。

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