Yoshino Yusuke, Abe Minami, Seo Kazunori, Koga Ichiro, Kitazawa Takatoshi, Ota Yasuo
Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan.
J Clin Med Res. 2014 Jun;6(3):215-7. doi: 10.14740/jocmr1732w. Epub 2014 Mar 31.
We report a rare case of disseminated gonococcal infection in a 37-year-old man presenting with multifocal cellulitis. The patient presented with fever and painful swelling of the right foot and left hand, and was admitted to our hospital. CT scanning of the extremities revealed multifocal cellulitis. Transthoracic echocardiography findings were normal, and piperacilin/tazoactam therapy was initiated. On antibiotic day 4, Neisseria gonorrhoeae was cultured from a purulent effusion collected from a focal site. Chlamydia trachomatis was detected in urine samples by PCR. We made the diagnosis of multifocal cellulitis due to N. gonorrhoeae in a patient with chlamydia urethritis. The antibiotic agent was changed from piperacilin/tazobactam to ceftriaxone. Levofloxacin was also administered for chlamydia urethritis. By admission day 14, all lesions had resolved and administration of antibiotic agents was terminated. Disseminated gonococcal infection, although rare, should be included in the differential diagnosis of all sexually active patients who present with multifocal cellulitis - also a rare condition, particularly in light of the fact that in recent times, patterns of sexual activity have changed, which was a pertinent factor in this case.
我们报告了一例罕见的播散性淋球菌感染病例,患者为一名37岁男性,表现为多灶性蜂窝织炎。该患者因右脚和左手发热及疼痛性肿胀入院。四肢CT扫描显示多灶性蜂窝织炎。经胸超声心动图检查结果正常,遂开始使用哌拉西林/他唑巴坦治疗。在使用抗生素第4天,从病灶部位采集的脓性渗出物中培养出淋病奈瑟菌。通过聚合酶链反应在尿液样本中检测到沙眼衣原体。我们诊断该衣原体尿道炎患者患有由淋病奈瑟菌引起的多灶性蜂窝织炎。抗生素由哌拉西林/他唑巴坦更换为头孢曲松。还给予左氧氟沙星治疗衣原体尿道炎。到入院第14天时,所有病灶均已消退,抗生素治疗终止。播散性淋球菌感染虽然罕见,但对于所有出现多灶性蜂窝织炎的性活跃患者都应列入鉴别诊断范围——多灶性蜂窝织炎本身也是一种罕见病症,特别是鉴于近期性行为模式发生了变化,这在本病例中是一个相关因素。