Takahashi Yoshinori, Sasabe Jun, Maeda Hikaru, Fujiwara Atsushi, Yuda Hisamichi, Yoshida Masamichi, Taguchi Osamu
Kansenshogaku Zasshi. 2014 Jul;88(4):463-8. doi: 10.11150/kansenshogakuzasshi.88.463.
A 63-year-old previously healthy man was admitted to our hospital with diarrhea that had lasted for about 4 weeks, high fever and dyspnea. Chest computed tomography showed consolidation with a low-density area in the right middle lobe and small nodules with feeding vessels in the right upper lobe. On Day 8, a cavity was observed in the consolidation, and the lymph nodes in the mediastinum became necrotic. Yersinia pseudotuberculosis (serotype 4b) was cultured from blood, bronchial washing fluid, and lung tissue specimens. We diagnosed the lung lesions as septic pulmonary embolism caused by enterocolitis. We started treatment with tazobactam/piperacillin. It has been reported that high-dose ceftriaxone (CTRX) is effective, but CTRX at normal doses and other beta-lactams are less effective or even ineffective. Therefore, we changed to CTRX (4g/day) on Day 5, CTRX (2g/day) on Day 8, and oral cefditoren pivoxil (600 mg/day; a third-generation cephalosporin) on Day 18. Antibiotic therapy resulted in a favorable response. The patient was discharged from our hospital on day 25 in good health. To the best of our knowledge, this is the first case of a lung abscess caused by Y. pseudotuberculosis reported in Japan.
一名63岁、既往健康的男性因腹泻持续约4周、高热和呼吸困难入院。胸部计算机断层扫描显示右中叶有实变伴低密度区，右上叶有带供血血管的小结节。第8天，实变区出现空洞，纵隔淋巴结坏死。从血液、支气管冲洗液和肺组织标本中培养出假结核耶尔森菌（血清型4b）。我们将肺部病变诊断为肠炎引起的脓毒性肺栓塞。我们开始使用他唑巴坦/哌拉西林进行治疗。据报道，大剂量头孢曲松（CTRX）有效，但正常剂量的CTRX和其他β-内酰胺类药物效果较差甚至无效。因此，我们在第5天改为CTRX（4g/天），第8天改为CTRX（2g/天），第18天改为口服头孢妥仑匹酯（600mg/天；第三代头孢菌素）。抗生素治疗取得了良好的效果。患者于第25天健康出院。据我们所知，这是日本报道的首例由假结核耶尔森菌引起的肺脓肿病例。
