Enterococcus faecalis Infection of Aortic Graft: A Case Report

糞腸球菌感染主動脈人工血管的病例報告

陳昶華(Chang-Hua Chen) ； 陳映澄(Ying-Cheng Chen)

《內科學誌》 24卷4期 (2013/08) Pp. 347-351

https://doi.org/10.6314/JIMT.2013.24(4).14

摘要

我們描述了一個罕見的糞腸球菌感染主動脈人工血管。一名61歲的男子被送往急診前3天開始發燒，發冷，和肌肉疼痛。在五年前，他因為主動脈剝離接受手術。入院時，他有發燒，白血球為6,600 mm^3，C-反應蛋白是14.68 mg/dL。在入院第三天，血液培養長出糞腸球菌（Enterococcus faecalis）。使用ampicillin每4小時2000毫克治療，67鎵（Ga-67）的報告，與單光子斷層掃描（SPET）發現主動脈弓有異常訊號。會診心血管外科醫生與評估手術時機。治療過程順利，抗生素總共使用三個月。腸球菌感染主動脈人工血管是一種危及生命的疾病。臨床醫師需要與心血管外科醫生評估手術條件並慎選抗生素治療。

並列摘要

We describe a rare case of aortic graft infection (AGI) due to Enterococcus faecalis (E. faecalis). A 61-year-old man was admitted with a 3-days history of fever, chills, and myalgia. He received operation for aortic dissection five years ago. Upon admission, he was febrile, and white blood cell count was 6,600/mm^3, and C-reactive protein was 14.68 mg/dL. On the 3rd admission day, the bacterium from blood was identified as E. faecalis. Ampicillin was initiated and its doseage was 2000 mg drip every 4 hours. The report of Gallium-67 (Ga-67) scan and single photon emission tomography (SPET) described an increased uptake of Ga-67 in the aortic arch. AGI was diagnosed. Cardiovascular surgeon was consulted to evaluate the surgical indication. The treatment course was smooth, and antibiotic was administrated for a total of three months. E. faecalis AGI is a life-threatening disease with devastating complications. In this patient, the infection was limited to the endograft. Cardiovascular surgeon should be involved to evaluate the benefit and risk of operation in AGI patients. Ga-67 scan and SPET are helpful to establish the diagnosis.

並列關鍵字

Enterococcus faecalis ； Aortic graft ； Infection