Blundell H J, Mason C A
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK.
BMJ Case Rep. 2015 Feb 19;2015:bcr2014207025. doi: 10.1136/bcr-2014-207025.
We report a case of a frail 82-year-old man with seronegative rheumatoid arthritis and a recent pacemaker insertion, admitted with pulmonary oedema and a symptomatic pericardial effusion. He was treated with diuretics and an urgent pericardiocentesis, a sample from which cultured Enterobacter cloacae. A subsequent abdominal CT scan revealed faecal loading, an abnormal anorectal canal and sigmoid colon and a bowel perforation. Endoscopy, biopsies and histopathology confirmed a diagnosis of cytomegalovirus (CMV) colitis with coexistent fungal infection. The E. cloacae infection was successfully treated with 6 weeks of intravenous meropenem, while the CMV and fungal infections were treated with a combination of valganciclovir and fluconazole. We postulate that the bowel perforation resulted from a combination of CMV colitis, faecal loading and steroid therapy and led to bacterial translocation of E. cloacae and the development of the pericardial effusion. This case represents an unusual pathophysiology for the development of an E. cloacae pericardial effusion.
我们报告一例病例，患者为一名82岁身体虚弱的男性，患有血清阴性类风湿性关节炎且近期植入了起搏器，因肺水肿和有症状的心包积液入院。他接受了利尿剂治疗及紧急心包穿刺术，心包穿刺抽取的样本培养出阴沟肠杆菌。随后的腹部CT扫描显示有粪便积滞、肛管和乙状结肠异常以及肠穿孔。内镜检查、活检和组织病理学确诊为巨细胞病毒（CMV）结肠炎合并真菌感染。阴沟肠杆菌感染通过静脉注射美罗培南治疗6周成功治愈，而CMV和真菌感染则采用缬更昔洛韦和氟康唑联合治疗。我们推测肠穿孔是由CMV结肠炎、粪便积滞和类固醇治疗共同作用所致，并导致了阴沟肠杆菌的细菌易位及心包积液的形成。该病例代表了阴沟肠杆菌心包积液发生的一种不寻常的病理生理过程。
