Ishizawa Jo, Mori Takehiko, Tsukada Yuiko, Matsuki Eri, Yokoyama Kenji, Shimizu Takayuki, Sugita Kayoko, Murata Mitsuru, Iwata Satoshi, Okamoto Shinichiro
Division of Hematology, Department of Medicine, Keio University School of Medicine, Central Clinical Laboratory, Keio University Hospital.
Rinsho Ketsueki. 2012 Jun;53(6):623-7.
A 62-year-old man with diffuse large B-cell lymphoma received five courses of R-CHOP chemotherapy. The patient developed cellulitis in the bilateral lower extremities without fever, and blood culture yielded Helicobacter cinaedi after five-day culture. Although the response to tazobactam/piperacillin (TAZ/PIPC) was prompt, cellulitis recurred immediately after discontinuation of the drug. Even after two months of treatment with PIPC plus amikacin followed by amoxicillin, it recurred again soon after stopping the antibiotics. H. cinaedi reportedly causes bacteremia and cellulitis in immunocompromised patients mostly in patients with acquired immunodeficiency syndrome. Only sporadic cases have been reported in association with hematological malignancies. Physicians should be aware of H. cinaedi as one of the causative pathogens of bacteremia and cellulitis in patients with hematological malignancies. Longer incubation period of blood culture is needed to detect the microbe and long-term use of antimicrobials is required to prevent recurrent cellulitis.
一名62岁的弥漫性大B细胞淋巴瘤男性患者接受了五个疗程的R-CHOP化疗。患者双下肢出现蜂窝织炎,无发热,血培养在培养五天后检出嗜沫嗜血杆菌。尽管患者对他唑巴坦/哌拉西林(TAZ/PIPC)反应迅速,但停药后蜂窝织炎立即复发。即使在使用哌拉西林加丁胺卡那霉素治疗两个月后再用阿莫西林治疗,停用抗生素后不久蜂窝织炎又复发。据报道,嗜沫嗜血杆菌主要在获得性免疫缺陷综合征患者等免疫功能低下患者中引起菌血症和蜂窝织炎。与血液系统恶性肿瘤相关的病例仅为散发病例。医生应意识到嗜沫嗜血杆菌是血液系统恶性肿瘤患者菌血症和蜂窝织炎的致病病原体之一。需要更长的血培养孵育时间来检测该微生物,并且需要长期使用抗菌药物以预防蜂窝织炎复发。