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[由气单胞菌属引起的伴有严重小肠结肠炎的造血系统肿瘤]

[Hematopoietic neoplasms accompanied by severe enterocolitis due to Aeromonas species].

作者信息

Miyamoto Yuka, Udaka Kengo, Sekimoto Etsuko, Shibata Hironobu, Otsuka Kanako, Mori Keiko, Shigekiyo Toshio, Ozaki Shuji

机构信息

Medical Education Center, Tokushima Prefectural Central Hospital.

Department of Hematology, Tokushima Prefectural Central Hospital.

出版信息

Rinsho Ketsueki. 2017;58(4):303-308. doi: 10.11406/rinketsu.58.303.

Abstract

Aeromonas species are known to be a cause of diarrhea and acute enterocolitis. However, only a few cases have been reported and the pathophysiology of Aeromonas infection has not as yet been clarified. We experienced 2 cases developing severe enterocolitis during the course of hematological malignancies, specifically multiple myeloma and diffuse large B-cell lymphoma. Both patients presented with watery diarrhea that persisted for more than a week, followed by bloody diarrhea. Total colon endoscopy showed multiple ulcers on the mucosa from the sigmoid colon to the rectum, and biopsies from the ulcer revealed infiltration of neutrophils and eosinophils in the mucosa and submucosa. Aeromonas hydrophila and Aeromonas sobria were isolated from stool cultures, respectively. Treatment with oral ciprofloxacin was effective in both patients and clinical symptoms showed significant improvement. These cases raise the possibility of Aeromonas infection as a cause of severe enterocolitis and the importance of making a correct differential diagnosis and appropriate antibiotic treatment in immunocompromised patients including those with hematological malignancies.

摘要

气单胞菌属已知是腹泻和急性小肠结肠炎的病因。然而,仅有少数病例报告,气单胞菌感染的病理生理学尚未阐明。我们遇到2例在血液系统恶性肿瘤病程中发生严重小肠结肠炎的病例,具体为多发性骨髓瘤和弥漫性大B细胞淋巴瘤。两名患者均出现持续一周以上的水样腹泻,随后出现血便。全结肠镜检查显示从乙状结肠到直肠的黏膜有多处溃疡,溃疡活检显示黏膜和黏膜下层有中性粒细胞和嗜酸性粒细胞浸润。分别从粪便培养物中分离出嗜水气单胞菌和温和气单胞菌。口服环丙沙星治疗对两名患者均有效,临床症状有显著改善。这些病例提示气单胞菌感染有可能是严重小肠结肠炎的病因,以及在包括血液系统恶性肿瘤患者在内的免疫功能低下患者中进行正确鉴别诊断和适当抗生素治疗的重要性。

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