Mycobacterium abscessus Empyema in an Immunocompromised Patient: A Case Report

免疫功能低下病人身上由快速生長型分枝桿菌所造成的膿胸：病例報告

林介惠(Chieh-Hui Lin) ； 覃俊士(Chun-Shih Chin) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 26卷1期 (2011/02) Pp. 33-38

https://doi.org/10.29806/TM.201102.0006

摘要

在免疫功能低下病人身上由快速生長型分枝桿菌(rapidly growing mycobacteria, RGM)所造成的膿胸很少被報導。一名70歲男子最初抱怨右側胸壁間歇性胸悶和悶痛。病人在社區醫院以細菌性肺炎治療。轉至我們醫院，由於AFS陽性即給予抗結核菌藥物。住院期間，發生右側膿胸，從痰和胸腔積液結核菌培養，病原體被確定為膿腫分枝桿菌(Mycobacterium abscessus)。我們安排剝除術與胸管引流治療，及靜脈注射cefoxitin，amikacin，及klaricid治療達3週。之後，病人持續以口服抗生素(klaricid, ofloxacin and doxycycline)治療，並於門診追蹤，保持穩定狀態。此案例表明，在台灣，尤其是免疫功能低下患者，膿腫分枝桿菌亦可能是膿胸的病原體之一。

關鍵字

快速生長型分枝桿菌 ； 非結核性分枝桿菌 ； 膿腫分枝桿菌 ； 膿胸

並列摘要

Thoracic empyema caused by rapidly growing mycobacteria in an immunocompetent patient is rarely reported. A 70-year-old man initially complained about intermittent chest tightness and dull pain at the right chest wall. The patient was diagnosed with and treated for bacterial pneumonia in a community hospital. Anti-tuberculosis agents were given in our ward because of a positive acid-fast stain finding in the sputum. During hospitalization, right thoracic empyema developed, and the pathogens from the sputum and pleural effusion were identified as Mycobacterium abscessus. Decortication with chest tube drainage was performed and intravenous cefoxitin, amikacin, plus klaricid therapy was administered for 3 weeks. The patient was continually monitored in our outpatient department, and was maintained in a stable condition with oral-form antibiotics (klaricid, ofloxacin and doxycycline). This case demonstrates that Mycobacterium abscessus is a pathogen that can cause thoracic empyema in Taiwan, especially in immunocompromised patients.

並列關鍵字

rapidly growing mycobacteria RGM ； non-tuberculous mycobacterial NTM ； Mycobacterium abscessus ； thoracic empyema