Tube Thoracostomy-Related Necrotizing Fasciitis: A Case Report

肺結核引發之氣胸經胸管引流併發壞死性筋脈炎－病例報告

許舜斌(Shun-Pin Hsu) ； 王鴻昌(Hong-Chung Wang) ； 黃雅堂(I-T Huang) ； 朱國安(Kuo-An Chu) ； 張晃宙(Huang-Chou Chang)

《The Kaohsiung Journal of Medical Sciences》 22卷12期 (2006/12) Pp. 636-640

摘要

肺結核引發之氣胸在醫學上並不常見，但卻常需施以緊急之胸管引流治療，否則將可能危及生命。不過胸管引流仍有它潛在的危險性，其中，壞死性筋脈炎爲一罕見但高死亡率之併發症。在此我們報告一位罕見因肺結核引發之氣胸，在施行胸管引流後導致壞死性筋脈炎的病例。46歲男性本身有糖尿病，此次由於氣促、胸痛來院，經診斷氣胸施予胸管引流治療。之後痰液檢查發現結核菌經抗結核藥治療。胸管雖在三天後即迅速移除，但仍不幸在五天後由引流位置擴展成壞死性筋脈炎。細菌經培養爲草綠鏈球菌及克雷伯氏桿菌。藉由抗生素治療及筋脈切開術等積極處理，病人在一個月後傷口痊癒出院，並維持抗結核病藥物治療。

關鍵字

壞死性筋脈炎 ； 氣胸 ； 肺結核 ； 胸管

並列摘要

Spontaneous pneumothorax is a serious complication of pulmonary tuberculosis that requires immediate treatment. Necrotizing fasciitis is a serious, rapidly progressive infection of the subcutaneous tissue and fascia, most related to trauma or surgery. Here, we report a case of pulmonary tuberculosis with spontaneous pneumothorax. A standard procedure of tube thoracostomy was performed for lung re-expansion. Two days after the tube was removed, necrotizing fasciitis developed from the puncture site. Computed tomography of the chest showed focal thickness with gas formation and loss of the fat plane over the chest wall, which is compatible with the diagnosis of necrotizing fasciitis. Aggressive treatment was given, including emergency fasciectomy and adequate systemic antibiotic and antituberculous treatment. The necrotizing fasciitis was successfully treated. The patient was discharged and sent home with maintenance antituberculous therapy.

並列關鍵字

necrotizing fasciitis ； pneumothorax ； pulmonary tuberculosis ； tube thoracostomy