Persistent Fever and Left Pleural Effusion Due to Occult Splenic Abscess in a Diabetic Patient on Long-Term Hemodialysis

長期血液透析病人之隱匿性脾膿腫引起持續發燒

鄭彩梅(Cai-Mei Zheng) ； 盧國城(Kuo-Cheng Lu) ； 鄭景泉(Jing-Quan Zheng) ； 楊麗瓊(Li-King Yang) ； 陳應盛(Yin-Sheng Chen) ； 冉祥俊(Hsiang-Chun Jan) ； 呂福江(Fur-Jiang Leu) ； 陳嘉美(Chia-Mei Chen) ； 曾金鳳(Chin-Feng Tseng)

《Acta Nephrologica》 24卷1期 (2010/03) Pp. 47-52

摘要

長期接受血液透析的病人最常見的罹病和死亡的原因為感染，尤其有糖尿病的患者發生率更高，而發燒是感染症最常見的臨床表現。無論是一般人或是接受洗血液透析的病人，脾膿腫是一種少見的敗血症感染來源，而且如果不及早診治，可能危及生命。我們報告一例糖尿病合併末期腎病患者接受長期血液透析治療，因為不明原因的發燒而住院，經診斷為中耳炎接受靜脈抗生素治療，但因高燒不退，且左胸腔出現積液，最後被診斷為隱匿性脾膿腫。細菌培養結果為罕見之黏質沙雷氏菌(Serratia marcescens)，病患接受手術及抗生素治療得以痊癒。

關鍵字

不明原因發燒 ； 脾膿瘍 ； 糖尿病 ； 血液透析

並列摘要

Splenic abscess is relatively rare and may he easily missed. It is mostly replace with commonly encountered in immunocompromised patients, such as patients with end-stage renal disease (ESRD) on long-term dialysis, particularly those with concomitant diabetes. In these patients, occult infections may have non-specific and atypical presentations. Patients usually present with unexplained fever and are susceptible to infection by unusual organisms which might cause delays in diagnosis and treatment. We present a diabetic patient with ESRD on long-term hemodialysis who developed persistent fever and left pleural effusion. He was eventually found to have splenic abscess due to an unusual pathogen, Serratia marcescens.

並列關鍵字

fever of unknown origin ； splenic abscess ； diabetes ； mellitus ； hemodialysis