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转移性乳腺癌患者因非创伤性感染导致的远处肌坏死。

Distant myonecrosis by atraumatic infection in a patient with metastatic breast cancer.

作者信息

Gray Kelsey M, Padilla Pablo L, Sparks Blake, Dziewulski Peter

机构信息

School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.

Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.

出版信息

IDCases. 2020 May 5;20:e00784. doi: 10.1016/j.idcr.2020.e00784. eCollection 2020.

Abstract

is an anaerobic, gram-positive bacillus known to cause myonecrosis, also known as gas gangrene, a life-threatening necrotizing soft tissue infection. Though it accounts for just 1 % of all infections attributable to spp., is a highly virulent and aggressive pathogen. Classic presentations of infection include bacteremia resulting in shock, myonecrosis, and vascular seeding. associated gas gangrene most commonly occurs in the setting of traumatic injury, but has also been reported in patients with colorectal malignancy, immunosuppression, neutropenia, and exceedingly rare in association with breast cancer. We report the case of a 56-year-old female patient with stage IV mixed lobar and ductal breast carcinoma with metastasis to the bone and liver, who presented with spontaneous myonecrosis of the right hand. No prior traumatic injury was noted. Following amputation of the right forearm, antibiotic treatment, and multiorgan support, the patient passed following transition to palliative care. We hope to increase awareness of this relatively uncommon, though potentially deadly pathogen, as well as to discuss treatment options in patients infected with .

摘要

是一种厌氧的革兰氏阳性杆菌,已知可引起肌坏死,也称为气性坏疽,是一种危及生命的坏死性软组织感染。尽管它仅占所有由该菌属引起的感染的1%,但却是一种高毒力和侵袭性的病原体。感染的典型表现包括导致休克的菌血症、肌坏死和血管播散。相关的气性坏疽最常见于创伤性损伤的情况下,但也有报道见于结直肠癌、免疫抑制、中性粒细胞减少的患者,与乳腺癌相关的情况极为罕见。我们报告了一例56岁女性患者,患有IV期混合性叶状和导管性乳腺癌并伴有骨和肝转移,该患者出现右手自发性肌坏死。未发现既往有创伤性损伤。在进行右前臂截肢、抗生素治疗和多器官支持后,患者在转为姑息治疗后去世。我们希望提高对这种相对不常见但可能致命的病原体的认识,并讨论感染该菌患者的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f77e/7218154/bf4280f3b88a/gr1.jpg

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