Mishra Shikha, Mann Baldeep, Besmanos Charizza, Raza Nadia, Heidari Arash
Internal Medicine, University of California, Los Angeles (UCLA) - Kern Medical, Bakersfield, USA.
Internal Medicine, University of California, San Francisco, Fresno, USA.
Cureus. 2023 Jun 5;15(6):e39978. doi: 10.7759/cureus.39978. eCollection 2023 Jun.
A 53-year-old Caucasian man with a history of alcohol use disorder, hypertension, and hypothyroidism presented with a myxedema coma requiring intubation. He had a complicated hospital course with ventilator-associated pneumonia with MRSA, sepsis with candida, and abdominal compartment syndrome requiring decompressive laparotomy. The patient slowly recovered during 43 days of hospitalization. During the intensive care unit (ICU) stay, a flexi-seal rectal tube was placed due to fecal incontinence. After being moved to a regular medicine unit, he started having loose watery stools with leukocytosis and neutrophilia. Clostridium difficile (C. diff.) colitis was suspected, and he was placed on oral vancomycin empirically. His stool test for C. diff. came back negative, and his rectal tube was subsequently removed. Imaging did not show any abscess, perforated viscus, or fistula formations. His stool culture grew a heavy colony of Pseudomonas aeruginosa (P. aeruginosa). Vancomycin was stopped, and he was started on oral ciprofloxacin 750 mg twice a day with complete resolution of his diarrhea and leukocytosis.
一名53岁的白种男性，有酒精使用障碍、高血压和甲状腺功能减退病史，因黏液性水肿昏迷需要插管而就诊。他的住院过程复杂，出现了耐甲氧西林金黄色葡萄球菌引起的呼吸机相关性肺炎、念珠菌败血症以及需要减压剖腹手术的腹腔间隔室综合征。患者在住院43天期间逐渐康复。在重症监护病房（ICU）住院期间，由于大便失禁放置了一根柔性密封直肠管。转至普通内科病房后，他开始出现稀水样便，伴有白细胞增多和中性粒细胞增多。怀疑患有艰难梭菌（C. diff.）结肠炎，经验性给予口服万古霉素治疗。他的艰难梭菌粪便检测结果为阴性，随后拔除了直肠管。影像学检查未显示任何脓肿、脏器穿孔或瘘管形成。他的粪便培养长出大量铜绿假单胞菌（P. aeruginosa）菌落。停用万古霉素，开始每天两次口服750 mg环丙沙星，腹泻和白细胞增多完全缓解。
