Kaga Akihito, Higo Ryuzaburo, Yoshikawa Hiroshi, Yokoi Naoko, Haruyama Takuo, Komatsu Hiroaki, Yabe Ayumi, Kusunoki Takeshi, Ikeda Katsuhisa
Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
Department of Otorhinolaryngology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
Auris Nasus Larynx. 2017 Dec;44(6):745-748. doi: 10.1016/j.anl.2016.10.009. Epub 2016 Nov 29.
We report the case of a patient with multiple empyema present throughout his body, including chronic sinusitis and chronic suppurative otitis media, as well as subsequent epidural empyema, all caused by Streptococcus intermedius. A 38-year-old man presented with chief complaints of headache, left ear discharge, and nasal congestion. Imaging studies revealed pansinusitis, soft tissue signs in the mastoid cells, and otitis media. The patient was treated with meropenem hydrate, 6g/day. While clinical findings indicated improvement of the sinusitis, his headache did not improve. Further examination with contrast computerized tomography (CT) 'a chest radiography' blood cultures were performed, and the patient was diagnosed with multiple empyema (with an epidural empyema, pulmonary suppuration) caused by S. intermedius. Subsequent burr hole drainage was implemented to drain the epidural empyema. Long-term administration was required to treat pulmonary suppuration. While they remain rare, there has been a recent upward trend in the frequency of cases in which a young, previously healthy patient has developed multiple empyema throughout their body despite the absence of complicating diseases that pose an immune deficiency risk, such as diabetes or infection with the human immunodeficiency virus (HIV). In order to properly diagnose and treat patients presenting with multiple empyema infection with S. intermedius should be included in the differential diagnosis.
我们报告了一例全身多处发生积脓的患者，包括慢性鼻窦炎和慢性化脓性中耳炎，以及随后发生的硬膜外积脓，所有这些均由中间型链球菌引起。一名38岁男性，主要症状为头痛、左耳流脓和鼻塞。影像学检查显示全鼻窦炎、乳突气房软组织征和中耳炎。患者接受了每日6克的美罗培南水合物治疗。虽然临床检查结果显示鼻窦炎有所改善，但他的头痛并未缓解。进一步进行了增强计算机断层扫描（CT）、胸部X线摄影和血培养检查，该患者被诊断为由中间型链球菌引起的多处积脓（伴有硬膜外积脓、肺化脓）。随后实施了钻孔引流以排出硬膜外积脓。治疗肺化脓需要长期给药。尽管此类病例仍然罕见，但最近出现了一种上升趋势，即年轻且先前健康的患者在没有诸如糖尿病或人类免疫缺陷病毒（HIV）感染等构成免疫缺陷风险的并发症的情况下，全身多处发生积脓。为了正确诊断和治疗出现多处积脓的患者，应将中间型链球菌感染纳入鉴别诊断。
