Adamski Jan K, Jäschke Björn B, Uusitalo-Seppälä Raija S, Moilanen Kalle V J, Pehkonen Antti V, Weigl Wojciech
Department of Anaesthesiology and Intensive Care, Satakunta Central Hospital, Pori, Finland.
Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland.
Case Rep Gastroenterol. 2017 Nov 29;11(3):748-754. doi: 10.1159/000484661. eCollection 2017 Sep-Dec.
Development of the extreme form of hypothyroidism defined as myxedema is very rare. Acute symptoms and their management have been described in detail previously. However, not much attention has been devoted to therapeutic challenges that are faced in the recovery phase of the treatment, especially pertaining to the gastrointestinal system. The link between myxedema and the appearance of severe infection (CDI) has not been established so far. A 61-year-old woman with no significant medical record was admitted to hospital because of infected heel pressure and thyroid dysfunction. A week later, due to hypothermia, hypotension, and unconsciousness, she was transferred to the intensive care unit. The clinical picture and the results of laboratory tests confirmed diagnosis of myxedema. After the introduction of resuscitative measures and hormonal substitution, patient's condition stabilized within 10 days. Due to concomitant sepsis, initially piperacillin/tazobactam and later cefuroxime were administered. After 20 days of antibiotic therapy, the patient developed CDI that was resistant to the routine mode of treatment. The clinical recovery was achieved only after a fecal microbiota transplantation procedure. The function of the digestive tract in myxedema is disturbed by gastric achlorydia and reduced peristalsis, which in turn can predispose the small intestine to overgrowth of bacteria. The use of antibiotics can additionally decrease the intestinal bacterial diversity, favoring the overgrowth of . The authors conclude that myxedema may increase the likelihood of a treatment-resistant form of CDI that requires the implementation of fecal microbiota transplantation.
黏液性水肿这种极端形式的甲状腺功能减退症的发展非常罕见。急性症状及其处理方法此前已详细描述过。然而，对于治疗恢复阶段所面临的治疗挑战，尤其是与胃肠道系统相关的挑战，关注并不多。黏液性水肿与严重感染（艰难梭菌感染，CDI）的出现之间的联系迄今尚未确立。一名无重大病史的61岁女性因足跟压力性感染和甲状腺功能障碍入院。一周后，由于体温过低、低血压和意识丧失，她被转入重症监护病房。临床表现和实验室检查结果确诊为黏液性水肿。在采取复苏措施和激素替代治疗后，患者的病情在10天内稳定下来。由于伴有败血症，最初给予哌拉西林/他唑巴坦，后来给予头孢呋辛。抗生素治疗20天后，患者发生了对常规治疗方式耐药的艰难梭菌感染。仅在进行粪便微生物群移植手术后才实现临床康复。黏液性水肿患者的消化道功能因胃酸缺乏和蠕动减弱而受到干扰，这反过来又可能使小肠易于细菌过度生长。使用抗生素还会进一步降低肠道细菌多样性，有利于……的过度生长。作者得出结论，黏液性水肿可能增加耐药性艰难梭菌感染的可能性，而这种感染需要实施粪便微生物群移植。
