以頸部膿瘍為初始表現之多重器官沙門氏桿菌感染

Multiple Organ Involvement of Salmonella Infection Presenting with Isolated Cervical Abscess

許原禎(Yuan-Jhen Hsu) ； 郭彥君(Ian-Jiun Kuo)

《台灣耳鼻喉頭頸外科雜誌》 49卷2期 (2014/06) Pp. 123-127

https://doi.org/10.6286/2014.49.2.123

摘要

沙門氏桿菌感染在臨床上通常以傷寒熱，腸胃炎與菌血症為主要表現，以深頸部感染為表現並不常見。回顧英文文獻，以深頸部膿瘍為初始表現合併多重器官感染尚未被報告。本科診治1名75歲男性病患，過去病史為第二型糖尿病合併慢性腎病變，來急診就醫時主述發燒合併右側頸部腫大3天。電腦斷層顯示於右側頸部level II和level III處有一大小4×3.5 cm膿瘍，病患接受深頸部膿瘍切除及氣管切開手術，血液與膿液細菌培養報告為B型沙門氏桿菌。術後住院當中陸續出現右上腹部腫脹與下背部疼痛的症狀：腹部超音波檢查發現一13.3cm巨大肝臟膿瘍，經腹部電腦斷層導引豬尾巴型導管（pig tail）引流，膿液細菌培養報告同樣為B型沙門氏桿菌；腰椎核磁共振發現第三節至第五節腰椎脊椎間盤炎（spondylodiscitis）合併雙側腰肌膿瘍（psoas abscess），病患接受腰椎清創與關節異體骨移植及融合手術，術後接受抗生素治療3週後出院，追蹤3年無復發跡象。沙門氏桿菌感染之深頸部膿瘍並不常見，耳鼻喉科醫師應注意其合併其他器官感染的特性，並及早發現治療。

關鍵字

非傷寒性沙門氏桿菌感染 ； 深頸部感染 ； 肝臟膿瘍 ； 脊椎間盤炎 ； 腰肌膿瘍

並列摘要

Salmonella species, a non-encapsulated Gram-negative motile bacillus, usually presents with typhoid fever, enterocolitis or bacteremia clinically. Neck abscess caused by Salmonella species is rarely reported. We report a 75 year-old male patient with type II diabetes mellitus admitted for high fever and rapidly growing neck mass for 3 days. Laboratory test showed leukocytosis and elevated C-reactive protein (CRP) level. Neck computed tomography without contrast revealed a 4 × 3.5 cm soft tissue mass at right level II and level III. Excision of right neck abscess and tracheostomy were performed due to persisted high fever, chills and dyspnea despite antibiotic treatment for 2 days. Salmonella serotype B were isolated from pus and blood culture. Right upper quadrant (RUQ) abdominal fullness was complained afterwards. The abdominal computed tomography disclosed a huge hepatic cystic tumor at S4, measuring 13.3 cm in width. Percutaneous pigtail catheter drainage was inserted and much pus (＞1000ml) was drained. Pus culture result from liver abscess was also Salmonella serotype B. Progressive low back pain developed, however, about 1 month later after admission. Lumbar spine MRI revealed bilateral psoas abscess formation and L3-L5 spine spondylodiscitis. Patient received debridement, posterior instrumentation and posterior lateral fusion. Treatment with fosfomycin for another 3 weeks was prescribed. The patient was free from recurrence of the disease after follow-up for 3 years. Deep neck infection, liver abscess and spondylodiscitis caused by Salmonella species simultaneously were firstly reported. The mechanism of the disseminated Salmonella infection and management are discussed. Otolaryngologist should be aware of the possibility of disseminated infection of non-typhoid Salmonella, especially in immune-compromised patients, when Salmonella deep neck infection is diagnosed.

並列關鍵字

non-typhoid Salmonella infection ； deep neck infection ； liver abscess ； spondylodiscitis ； psoas abscess