生体腎移植患者に発症し集中治療を要したNocardia farcinicaによる播種性ノカルジア症の1例
症例は62歳，男性．慢性腎不全のため両側腎に対して生体腎移植後であり，メチルプレドニゾロン，タクロリムス，ミコフェノール酸モフェチルを投与中であった．2017年10月2日から吸気時の右胸痛を自覚したため近医を受診したが，肋間神経痛として帰宅していた．10月12日に胸痛の増悪を認めたため当院へ救急搬送となった．胸部CTで右胸膜に接して肺膿瘍を認め，喀痰培養および血液培養からKinyoun染色陽性のグラム陽性桿菌を認めた．治療開始数日で呼吸不全の悪化を認め，一時的に人工呼吸器管理を要した．後日培養結果でNocardia farcinicaと判明したため治療を継続し，改善を認めた．第44病日に頭部M...
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| Published in | 岩手医学雑誌 Vol. 72; no. 1; pp. 31 - 37 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
岩手医学会
01.04.2020
|
| Online Access | Get full text |
| ISSN | 0021-3284 2434-0855 |
| DOI | 10.24750/iwateishi.72.1_31 |
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| Abstract | 症例は62歳，男性．慢性腎不全のため両側腎に対して生体腎移植後であり，メチルプレドニゾロン，タクロリムス，ミコフェノール酸モフェチルを投与中であった．2017年10月2日から吸気時の右胸痛を自覚したため近医を受診したが，肋間神経痛として帰宅していた．10月12日に胸痛の増悪を認めたため当院へ救急搬送となった．胸部CTで右胸膜に接して肺膿瘍を認め，喀痰培養および血液培養からKinyoun染色陽性のグラム陽性桿菌を認めた．治療開始数日で呼吸不全の悪化を認め，一時的に人工呼吸器管理を要した．後日培養結果でNocardia farcinicaと判明したため治療を継続し，改善を認めた．第44病日に頭部MRIで多発脳膿瘍を認め，播種性ノカルジア症による脳膿瘍として治療を追加した．免疫能の低下を認める患者における呼吸器感染症としてノカルジア症は鑑別に挙げるべき疾患と考える． |
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| AbstractList | 症例は62歳，男性．慢性腎不全のため両側腎に対して生体腎移植後であり，メチルプレドニゾロン，タクロリムス，ミコフェノール酸モフェチルを投与中であった．2017年10月2日から吸気時の右胸痛を自覚したため近医を受診したが，肋間神経痛として帰宅していた．10月12日に胸痛の増悪を認めたため当院へ救急搬送となった．胸部CTで右胸膜に接して肺膿瘍を認め，喀痰培養および血液培養からKinyoun染色陽性のグラム陽性桿菌を認めた．治療開始数日で呼吸不全の悪化を認め，一時的に人工呼吸器管理を要した．後日培養結果でNocardia farcinicaと判明したため治療を継続し，改善を認めた．第44病日に頭部MRIで多発脳膿瘍を認め，播種性ノカルジア症による脳膿瘍として治療を追加した．免疫能の低下を認める患者における呼吸器感染症としてノカルジア症は鑑別に挙げるべき疾患と考える． |
| Author | 寺山, 茉莉 鈴木, 利央登 鳴海, 新介 丹田, 実 井上, 義博 |
| Author_xml | – sequence: 1 fullname: 鈴木, 利央登 organization: Iwate Prefectural Advanced Critical Care and Emergency Center, Yahaba, Japan – sequence: 1 fullname: 寺山, 茉莉 organization: Iwate Prefectural Advanced Critical Care and Emergency Center, Yahaba, Japan – sequence: 1 fullname: 井上, 義博 organization: Iwate Prefectural Advanced Critical Care and Emergency Center, Yahaba, Japan – sequence: 1 fullname: 鳴海, 新介 organization: 岩手医科大学医学部，内科学講座神経内科・老年科分野 – sequence: 1 fullname: 丹田, 実 organization: Iwate Prefectural Advanced Critical Care and Emergency Center, Yahaba, Japan |
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| References | Kanne JP, Yandow DR, Mohammed TL, et al.: CT findings of pulmonary nocardiosis. AJR Am J Roentgenol 197, W266-272, 2011. Pintado V, Mampaso EG, Fortun J, et al.: Infection with nocardia species : clinical spectrum of disease and species distribution in Madrid, Spain, 1987-2001. Infection 30, 338-340, 2002. Rosett W and Hodges GR: Recent experiences with nocardial infections. Am J Med Sci 276, 279-285, 1978. 中村茂樹，三原 智，一ツ松 勤，他：高齢塵肺患者に発症した播種性ノカルジア症の1例．感染症誌 80, 721-725, 2006. Minero MV, Marin M, Cercenado E, et al.: Nocardiosis at the turn of the century. Medicine (Baltimore) 88, 250-261, 2009. Malincarne L, Marroni M, Farina C, et al.: Primary brain abscess with nocardia farcinica in an immunocompetent patient. Clin Neurol Neurosurg 104, 132-135, 2002 Yamaguchi H, Komase Y, Wakatake H, et al.: An autopsy case of disseminated nocardiosis involving multiple organs associated with chemotherapy-induced lung damage following lung cancer surgery. J St Marianna Univ 5, 131-138, 2014. Frazier AR, Rosenow EC and Roberts G: Nocardiosis : a review of 25 cases occurring during 24 months. Mayo Clin Proc 50, 657-663, 1975. Segawa S, Nishimura M, Sogawa K, et al.: Identification of Nocardia species using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. Clin Proteomics 12, 6, 2015. Beaman BL, Burnside J, Edwards B, et al.: Nocardial infection in the United States, 1972-1974. J Infect Dis 134, 286-289, 1976. Yorke RF and Rouah E: Nocardiosis with brain abscess due to an unusual species, nocardia transvalensis. Arch Pathol Lab Med 127, 224-226, 2003. Schlaeffer F, Risenberg K and Mikolich D: Serious bacterial infections after endoscopic procedures. Arch Intern Med 156, 572, 1996. Lerner PI: Nocardiosis. Clin Infect Dis 22, 891, 1996. 滝口恭男，潤間励子：肺ノカルジア感染症の検討．日呼吸会誌 42, 810-814, 2004. Uhde KB, Pathak S, McCullum I Jr, et al.: Antimicrobiral-resistant Nocardia isolates, United States, 1995-2004. Clin Infect Dis 51, 1445-1448, 2010. 長島 修，佐々木信一，難波由喜子，他：肺膿瘍の起因菌および臨床的背景の検討．日呼吸会誌 49, 623-628, 2011. Wilson JP, Turner HR, Kirchner KA, et al.: Nocardial infections in renal transplant recipients. Medicine 68, 38, 1989. Georghiou PR and Blacklock ZM: Infection with nocardia species in Queensland. A review of 102 clinical isolates. Med J Aust 156, 692-697, 1992. Mamelak AN, Obana WG and Flaherty JF: Nocardial brain abscess: treatment strategies and factors influencing outcome. Neurosurgery 35, 622-631, 1994. Threlkeld SC and Hooper DC: Update on management of patients with nocardia infection. Curr Clin Top Infect Dis 17, 1-23, 1997. Lumb R, Greville H, Martin J, et al.: Nocardia asteroides isolated from three patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis 21, 230-233, 2002. Brown-Elliott BA, Brown JM, Conville PS, et al.: Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev 19, 259-282, 2006. McNeil MM, Brown JM, Hutwagner LC, et al.: Evaluation of therapy for Nocardia asteroids complex infection. Infect Dis Clin Prac 4, 287, 1995. 松尾 潔，竹内仁志，河田典子，他：Nocardia otitidiscaviarumによる肺ノカルジア症の1例．日呼吸会誌 79, 879-890, 2004. |
| References_xml | – reference: Wilson JP, Turner HR, Kirchner KA, et al.: Nocardial infections in renal transplant recipients. Medicine 68, 38, 1989. – reference: Lerner PI: Nocardiosis. Clin Infect Dis 22, 891, 1996. – reference: Malincarne L, Marroni M, Farina C, et al.: Primary brain abscess with nocardia farcinica in an immunocompetent patient. Clin Neurol Neurosurg 104, 132-135, 2002 – reference: Beaman BL, Burnside J, Edwards B, et al.: Nocardial infection in the United States, 1972-1974. J Infect Dis 134, 286-289, 1976. – reference: Schlaeffer F, Risenberg K and Mikolich D: Serious bacterial infections after endoscopic procedures. Arch Intern Med 156, 572, 1996. – reference: Georghiou PR and Blacklock ZM: Infection with nocardia species in Queensland. A review of 102 clinical isolates. Med J Aust 156, 692-697, 1992. – reference: 中村茂樹，三原 智，一ツ松 勤，他：高齢塵肺患者に発症した播種性ノカルジア症の1例．感染症誌 80, 721-725, 2006. – reference: 滝口恭男，潤間励子：肺ノカルジア感染症の検討．日呼吸会誌 42, 810-814, 2004. – reference: Brown-Elliott BA, Brown JM, Conville PS, et al.: Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev 19, 259-282, 2006. – reference: 長島 修，佐々木信一，難波由喜子，他：肺膿瘍の起因菌および臨床的背景の検討．日呼吸会誌 49, 623-628, 2011. – reference: Frazier AR, Rosenow EC and Roberts G: Nocardiosis : a review of 25 cases occurring during 24 months. Mayo Clin Proc 50, 657-663, 1975. – reference: Kanne JP, Yandow DR, Mohammed TL, et al.: CT findings of pulmonary nocardiosis. AJR Am J Roentgenol 197, W266-272, 2011. – reference: Rosett W and Hodges GR: Recent experiences with nocardial infections. Am J Med Sci 276, 279-285, 1978. – reference: 松尾 潔，竹内仁志，河田典子，他：Nocardia otitidiscaviarumによる肺ノカルジア症の1例．日呼吸会誌 79, 879-890, 2004. – reference: McNeil MM, Brown JM, Hutwagner LC, et al.: Evaluation of therapy for Nocardia asteroids complex infection. Infect Dis Clin Prac 4, 287, 1995. – reference: Yorke RF and Rouah E: Nocardiosis with brain abscess due to an unusual species, nocardia transvalensis. Arch Pathol Lab Med 127, 224-226, 2003. – reference: Mamelak AN, Obana WG and Flaherty JF: Nocardial brain abscess: treatment strategies and factors influencing outcome. Neurosurgery 35, 622-631, 1994. – reference: Yamaguchi H, Komase Y, Wakatake H, et al.: An autopsy case of disseminated nocardiosis involving multiple organs associated with chemotherapy-induced lung damage following lung cancer surgery. J St Marianna Univ 5, 131-138, 2014. – reference: Minero MV, Marin M, Cercenado E, et al.: Nocardiosis at the turn of the century. Medicine (Baltimore) 88, 250-261, 2009. – reference: Pintado V, Mampaso EG, Fortun J, et al.: Infection with nocardia species : clinical spectrum of disease and species distribution in Madrid, Spain, 1987-2001. Infection 30, 338-340, 2002. – reference: Uhde KB, Pathak S, McCullum I Jr, et al.: Antimicrobiral-resistant Nocardia isolates, United States, 1995-2004. Clin Infect Dis 51, 1445-1448, 2010. – reference: Lumb R, Greville H, Martin J, et al.: Nocardia asteroides isolated from three patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis 21, 230-233, 2002. – reference: Threlkeld SC and Hooper DC: Update on management of patients with nocardia infection. Curr Clin Top Infect Dis 17, 1-23, 1997. – reference: Segawa S, Nishimura M, Sogawa K, et al.: Identification of Nocardia species using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. Clin Proteomics 12, 6, 2015. |
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| Title | 生体腎移植患者に発症し集中治療を要したNocardia farcinicaによる播種性ノカルジア症の1例 |
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