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題名 | 糖尿病合併腎病症候群的病人發生原發性內收肌群化膿性肌炎--病例報告=Primary Pyomyositis of the Adductor Muscles in a Diabetic Patient with Nephrotic Syndrome--Case Report |
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作者 | 何泰儀; 張至宏; 洪冠予; 蔡敦仁; | 書刊名 | 內科學誌 |
卷期 | 13:2 2002.04[民91.04] |
頁次 | 頁109-114 |
分類號 | 415.762 |
關鍵詞 | 化膿性肌炎; 內收肌群; 金黃色葡萄球菌; 糖尿病; 腎病症候群; Pyomyositis; Adductor muscles; Staphylococcus aureus; Diabetes mellitus; Nephrotic syndrome; |
語文 | 中文(Chinese) |
中文摘要 | 化膜性肌炎是橫紋肌遭細菌感染造成的疾病。本文報告一例糖尿病合併腎病症候 群的患者 , 發生大腿內收肌群的原發性化膿性肌炎。病患、為 45 歲男性 , 有糖尿 病 10餘年病史 , 住院前約一個月起病患下肢出現浮腫現象 , 這段期間並未有遭受外傷、撞擊、接受針灸、或針筒注射等情形。病患因右腿腫痛加劇及發燒來院 求診 , 實驗室檢查發現白血球升高 , 而在細菌性感染的診斷下安排住院 , 並開始 經驗性抗生素治療。住院後軟組織超音波在右大腿肌肉層發現有不規則低回音區 域 , 疑為膜腫形成。進一步安排核磁共振掃描檢查 , 發現一處具高信號強度團塊 伴隨中心性壞死區域分布於右腿內收肌群。以針筒進行抽吸 , 抽吸液經細胞學檢 查含大量發炎細胞 , 而細菌培養結果為對 methicillin 具感受性之金黃色葡萄球菌 (methicillin-sensitive Staphylococcus aureus,MSSA) 。住院後第 7 天進行手術處理 , 術中發現右側內收肌群內有多個不規則分葉狀的脹腫 , 其中最大者位於內收 大肌 (m.adductor magnus ) 。對病灶進行切開及引流後 , 術中病灶膿液亦送細菌 培養 , 兩天後報告結果亦為 MSSA 。經過 cehzolin 四週及口服 cefadroxil 二週的治療後 , 病人順利出院。查閱英文文 獻發現侵犯大腿內收肌群的化膜性肌炎相當罕見 , 我們對此現象提出可能的解 釋 , 並綜合前人對化膿性肌炎的報告進行回顧與討論。 |
英文摘要 | Pyomyositis is infection of the striated muscle. In this report, we described a diabetic patient with nephro-tic syndrome, who suffered from Staphylococcus aureus pyomyositis without antecedent predisposing event. The 45-year-old man was admitted for legs swelling and fever. Magnetic resonance images revealed homogeneous enhancement of adductor magnus muscle and adjacent tissue. There is a hypointense region within the adductor magnus muscle, which is compatible with abscess. Pus-like material from both needle aspiration and surgical debridement yielded methicillin-sensitive Staphylococcus aureus (MSSA). The patient improved after the operation and antibiotic treatment. Pyomyositis rarely occurred within adductor muscles. The possible mechanisms leading to this rare complication in diabetic patients were also discussed. ) (J Intern Med Taiwan 2002;13:109-114 ) |
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