- 期刊
菌血症同時併發頸椎硬腦膜上膿瘍及心包膜積水：病例報告
Bacteremia Complicated Simultaneously with Cervical Epidural Abscess and Pericardial Effusion: A Case Report
摘要
隨著醫學影像及診斷的進步，許多脊椎的疾病都可以得到適當的處置。然而，對於硬腦膜上膿瘍(epidural abscess)的診斷及處理，尤其是早期的診斷及治療，以避免嚴重的神經學後遺症，對於醫師仍是一個極大的挑戰。 本病例報告為一位46歲因發燒、全身無力而至本院急診求診之病人，診斷為金黃色葡萄球菌敗血症(Staphylococcus aureus sepsis)而到本院住院接受抗生素治療，並且在住院的第二天體溫即恢復正常。不幸地，在住院後的第3個禮拜，病人又開始發燒，心臟超音波檢查發現大量心包膜積水(pericardial effusion)，因此接受心包膜切開術(pericardiotomy)以治療心包膜積水。然而在開完刀的隔天清晨，突然發生四肢癱瘓(tetraplegia)，核磁共振檢查發現頸椎硬腦膜上有膿瘍，病人立刻接受神經外科手術。此膿瘍之細菌培養結果和之前的血液細菌培養結果相同，可以推論感染源是來自次發性之血行性感染。由於心包膜發炎的症狀也可以脖子疼痛來表現，容易和頸椎硬腦膜上膿瘍的症狀混淆，因此在處理高危險性之病人時須要保持高度的警戒心，才不會因為同時合併有其它的疾病而延誤了硬腦膜上膿瘍的診斷及早期治療。
並列摘要
Despite advances in neuroimaging technology and neurosurgical treatment, spinal epidural abscess remains a challenging problem. Early diagnosis is difficult and thus treatment is often too late to prevent severe neuro- logical sequelae. A 46 years old male was admitted to our emergency department due to fever and general weakness. Under the impression of sepsis due to Staphylococcus aureus, he was admitted for further antibiotic treatment. Fever subsided one day after parenteral antibiotic usage. Unfortunately, fever recurred three weeks later accompaning with neck pain, cough, dypsnea and skin rash. Chest roentgenogram revealed rapid progressive cardiomegaly. Cardiac ultrasonographic examination noted large amount of pericardial effusion. Therefore, pericardiotomy and effusion drainage were performed. Tetraplegia developed in the next morning. Emergent magnetic resonance imaging (MRI) showed cervical epidural abscess and surgery was performed. The result of bacteria culture from the abscess was the same as the previous blood culture. So secondary hematogeneous spinal infection was diagnosed. The initial presentation of the epidural abscess is often nonspecific. Furthermore, the manifestation of pericarditis can also be neck pain, which makes the concurrent epidural abscess more difficult to be detected and be early treated. This case report aims at reminding the clinician to keep highly alert when facing the patient with high risk for epidural abscess.