Otera Hiroshi, Yamamoto Go, Ohkusu Kiyofumi, Kozuki Haruka, Hashimoto Kimio, Tada Kimihide
Department of Respiratory Medicine, Nishi-Kobe Medical Center, Japan.
Intern Med. 2012;51(17):2463-7. doi: 10.2169/internalmedicine.51.7626. Epub 2012 Sep 1.
A 62-year-old man presented with general fatigue. He was diagnosed with septic shock and severe pneumonia. The sputum at admission yielded methicillin-sensitive Staphylococcus aureus (MSSA) strain and methicillin-resistant S. aureus (MRSA) strain. Despite antibiotic treatment, he did not improve. A chest computed tomography (CT) revealed multilobar cavity lesions. Only MRSA strain was confirmed at that time. We diagnosed him with necrotizing pneumonia. Despite treatment with vancomycin, his pneumonia worsened and he died. At autopsy, many gram-positive cocci were observed in the lungs. The clinical presentation of our patient was different from typical CA-MRSA-mediated necrotizing pneumonia.
一名62岁男性因全身乏力就诊。他被诊断为感染性休克和重症肺炎。入院时痰液培养出对甲氧西林敏感的金黄色葡萄球菌（MSSA）菌株和耐甲氧西林金黄色葡萄球菌（MRSA）菌株。尽管进行了抗生素治疗，他的病情并未改善。胸部计算机断层扫描（CT）显示多叶空洞性病变。当时仅确认有MRSA菌株。我们诊断他为坏死性肺炎。尽管使用万古霉素治疗，他的肺炎仍恶化，最终死亡。尸检时，在肺部观察到许多革兰氏阳性球菌。我们患者的临床表现与典型的社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）介导的坏死性肺炎不同。
