Lung Abscess with Thoracic Wall Invasion Caused by Enterococcus Faecium-A Rare Case Report

儘管抗生素治療的進步，肺膿瘍造成的死亡仍然相當顯著。肺膿瘍合併胸壁感染並不常見，其致病菌大多是結核菌，土壤絲菌和放射菌。我們報告一個53歲男性急性髓性白血病例，他罹患腸球菌肺膿瘍合併胸壁感染。患者在剛入院接受化學治療時，胸部X光檢查為正常。但是在化學治療兩週之後，發生嗜中性白血球低下合併發燒，胸部X光顯示右下肺部有一片明顯浸潤病灶。後續的胸部電腦斷層攝影發現肺膿瘍合併胸壁感染。經由胸壁穿刺抽吸肺膿瘍及胸壁病灶之後，細菌培養結果為糞腸球菌(Enterococcus faecium)。此患者之肺膿瘍在有效的抗生素治療之後得到初步的改善，不幸的是病人的髓性白血病持續惡化，同時因為肺部感染擴大合併呼吸衰竭而死亡。據吾人所知，此病例是第一例因為腸球菌導致肺膿瘍合併胸壁感染的案例。由於此種病菌之抗藥性強，一般之廣效性抗生素均無效，須以抽吸物作培養以得到正確診斷，並須給予夠長之有效抗生素治療。

關鍵字

腸球菌；肺膿瘍；胸壁感染

並列摘要

Lung abscess causes significant morbidity and mortality despite advances in diagnostic modalities and antibiotic therapy. Lung abscess with thoracic wall infection is an unusual complication and the causative pathogens are mostly Mycobacterium tuberculosis, Nocardia and Actinomycetes. We report a case of Enterococcus lung abscess with thoracic wall infection in a 53-year-old male with acute myelogenous leukemia (AML). The chest radiograph was unremarkable when he was admitted for induction chemotherapy. However, neutropenic fever developed and the chest radiograph revealed a patchy lesion in the right lower lung field 2 weeks after chemotherapy. Subsequent chest computed tomography showed a lung abscess with thoracic wall invasion. Pus cultures following transthoracic needle aspiration of the lung abscess and infected thoracic wall yielded Enterococcus faecium. Unfortunately, the patient died of deteriorated AML and pulmonary infection 4 months later, despite aggressive antibiotics treatment. To our knowledge, this is the first case of Enterococcus spp.-related lung abscess with thoracic wall infection. Physicians should be alert for this pathogen when patients are refractory to empirical antibiotics treatment and in an immunocompromised status.

並列關鍵字

Enterococcus ； lung abscess ； thoracic wall invasion

國際替代計量

Lung Abscess with Thoracic Wall Invasion Caused by Enterococcus Faecium-A Rare Case Report

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