Melioidosis Presenting as Splenic Abscesses and Suspected Septic Pulmonary Embolism- A Case Report

類鼻疽感染症以脾膿瘍及疑似敗血性肺栓塞表現－案例報告

張子晏(Tz-Yan Chang) ； 李原地(Yuan-Ti Lee) ； 吳子卿(Tzu-Chin Wu) ； 劉旭崇(Hsu-Chung Liu)

《胸腔醫學》 30卷5期 (2015/10) Pp. 280-285

摘要

49歲男性病人新診斷的第二型糖尿病，住高雄地區，這次因為發燒及寒顫症狀持續一個月就診。住院理學檢查發現腹部肝脾部位有壓痛感。腹部電腦斷層顯示脾臟有多個低顯影病灶且符合脾膿瘍影像表現。住院一週後，追蹤胸部X光發現雙肺有新的多發性肺泡型及結節型浸潤。因感染科醫師建議及脾膿瘍的感染源控制，病人接受脾臟切除手術。之後，病人的血液、脾膿瘍、及痰液培養結果均檢出類鼻疽桿菌，確立診斷為類鼻疽感染症以及以脾膿瘍、菌血症、與疑似敗血性肺栓塞等表現。即使使用適當的抗生素治療及積極急救處置，病患仍在住院兩週後因敗血性休克死亡。這個案例顯示一個類鼻疽感染症和糖尿病控制不佳的病人，可能以脾膿瘍、敗血性肺栓塞、及不好的預後等表現。

關鍵字

類鼻疽感染症 ； 肺栓塞 ； 脾膿瘍

並列摘要

A 49-year-old man with newly-diagnosed type 2 diabetes and living in Kaohsiung presented with fever and chills for 1 month. On admission, physical examination revealed persistent abdominal tenderness in the region of the liver and spleen. Contrast-enhanced computed tomography of the abdomen disclosed multiple low attenuation lesions in the spleen, which were compatible with splenic abscesses. One week after admission, followup chest radiography revealed multiple alveolar and nodular infiltrates in both lungs. Splenectomy for infection control of the splenic abscess was performed at the suggestion of our infectious disease specialist. Burkholderia pseudomallei was isolated in cultures of the blood, splenic abscess, and sputum. The diagnosis of melioidosis with presentations of splenic abscesses, bacteremia, and suspected septic pulmonary embolism was made. Two weeks after admission, the patient expired due to refractory septic shock, even with adequate antibiotic treatment and aggressive resuscitative management. This case highlights the possibility that a patient with melioidosis and uncontrolled diabetes could present with splenic abscess, septic pulmonary embolism, and a poor prognosis.

並列關鍵字

melioidosis ； pulmonary embolism ； splenic abscess