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題 名 | Spontaneous Gas Gangrene in a Leukemia Patient--A Case Report=發生在白血病患者身上的自發性氣性壞疽--病例報告 |
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作 者 | 莊濬綦; 李俊達; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 28:2 2019.06[民108.06] |
頁 次 | 頁160-166 |
分類號 | 416.15 |
關鍵詞 | 白血病; 自發性氣性壞疽; 梭菌性肌肉壞死; Spontaneous gas gangrene; Clostridial myonecrosis; |
語 文 | 英文(English) |
中文摘要 | 背景:在有血液疾病的病人身上,梭菌感染是最嚴重的一種併發症,而自發性氣性壞疽,或者稱作梭菌性肌肉壞死,是梭菌感染的一種少見的表現。材料及方法:我們報告一位43歲被診斷患有急性骨髓性白血病第三型的男性,他在接受兩階段的化學治療之後,骨髓檢查發現完全緩解。然而在第三階段化學治療期間,他出現了白血球低下,咳嗽及口腔黏膜潰瘍的症狀,並且在某一天晚上突然出現左上臂劇烈疼痛的狀況,他接受緊急電腦斷層的檢查並發現在左上臂有氣體出現,我們馬上幫他安排緊急筋膜切開術來達到感染控制。結果:這一位病患在手術後隔天死亡,手術傷口的細菌培養長出產氣莢膜梭菌。我們做了文獻搜尋,針對有血液惡性疾病的病患出現因產氣莢膜梭菌所造成的自發性氣性壞疽,所有的病人皆死亡。結論:自發性氣性壞疽是致命的疾病,而且常常發生在免疫功能低下的人身上,主要的處置辦法是早期診斷、抗生素使用、以及緊急清創手術。儘管以上的處置,自發性氣性壞疽仍然會造成極高的死亡率。 |
英文摘要 | Background: Clostridial infection is one of the most severe infectious complications in patients with hematological diseases. Spontaneous gas gangrene (SGG) or clostridial myonecrosis is a rare presentation of clostridial infection. Materials and Methods: We present a 43-year-old man, who was diagnosed with acute promyelocytic leukemia (APL). He had received two courses of chemotherapy. Bone marrow examination was conducted and the results showed complete remission. During the third course of chemotherapy, he developed neutropenia, cough, and oral ulceration. He complained of sudden onset pain in the left arm. Emergent computed tomography showed free air accumulation in the left arm, for which he underwent emergent fasciotomy. Results: The patient died on the next day of surgery. Clostridium perfringens was isolated from the lesion in the left arm. A literature reviews revealed that adult patient with hematological malignancies presented SGG caused by C. perfringens, all these patients had poor outcomes. Conclusion: SGG is fatal and usually occurs in immunocompromised patients. The main management strategies are early diagnosis, antibiotic use, and emergent debridement. Despite these strategies, SGG is still associated with a high mortality rate. |
本系統中英文摘要資訊取自各篇刊載內容。