- 期刊
Spondylodiscitis and Infective Endocarditis Caused by Streptococcus Bovis in a Patient with Colon Cancer
牛鏈球菌在一位大腸癌病人引起的感染性脊椎間盤炎及心內膜炎
摘要
骨骼肌肉系統不適是病患常見的問題，尤其在老年病患；類似症狀亦會發生在患有感染性心內膜炎的病人中，卻常被當成風溼性或退化性關節炎來處理，其中少數可能會合併有感染性脊椎炎，尤其是鍊球菌類感染性心內膜炎；若是由牛鏈球菌引起之菌血症或感染性心內膜炎，則需注意是否有合併結腸病灶；本研究報告一位64歲老年男性，因運動性呼吸困難，進一步診斷爲牛鏈球菌菌血症併感染性心內膜炎，雖無腸道症狀，安排大腸鏡檢後發現盲腸有初期大腸癌病灶，並接受右結腸部分切除，診治期間亦併發嚴重下背痛，經核磁共振檢查發現第四、五腰椎脊椎椎間盤炎，接受清創併骨移植手術，在合併使用抗生素控制感染之下，術後恢復狀況良好，沒有再出現症狀。對於患有牛鏈球菌菌血症或感染性心內膜炎之病患，應警覺是否併有結腸病灶，而病患之骨骼肌肉系統不適，亦應小心評估是否有感染之虞。
並列摘要
Musculoskeletal symptoms are complaints especially common in the elderly. Similar symptoms also occur in patients with infective endocarditis; they are often treated as rheumatic or degenerative diseases. In patients with infective endocarditis, symptoms may also be complicated with vertebral osteomyelitis, especially streptococcal infective endocarditis. Literature review indicates that, in patients, especially the elderly who have bacteremia and/or endocarditis from Streptococcus bovis, investigation of colonic lesions is optimal. The study reports a 64-year-old male patient with initial presentation of exertional dyspnea. Bacteremia and endocarditis from S. bovis was diagnosed. Colonoscopy showed a colon cancer in early stage over cecum. The patient underwent right hemicolectomy and had new onset of severe low back pain during this period. Magnetic resonance imaging revealed spondylodiscitis over low lumbar spine. He underwent debridment and anterior interbody fusion. Under the cover of antibiotics, he recovered well. For patients, who have bacteremia and/or endocarditis from S. bovis, screening test should be arranged under the suspicion of colon lesion, especially in the elderly. Moreover, the musculoskeletal symptoms should be treated with care for the possibility of infection.
延伸閱讀
- Lin, S. M., Horng, C. T., Chen, J. T., Lu, D. W., & Tsai, M. L. (2015). 僵直性脊椎炎病人接受腫瘤壞死因子抑制劑治療後巨細胞病毒前葡萄膜炎復發：病例報告. 中華民國眼科醫學會雜誌, 54(), 35-41. https://www.airitilibrary.com/Article/Detail?DocID=10213120-201510-201604280052-201604280052-35-41
- Hsu, J. F., Huang, J. L., & Hung, I. J. (1996). 鏈球菌引致反應性關節炎：一病例報告. Acta Paediatrica Sinica, 37(4), 295-297. https://doi.org/10.7097/APS.199608.0295
- Yang, C. H. (2010). 大腸桿菌三尖瓣心內膜炎：一病例報告. 內科學誌, 21(5), 373-377. https://doi.org/10.6314/JIMT.2010.21(5).10
- Chen, Y. F., Liu, J. D., Chang, C. C., Chen, S. H., Pan, S., & Lin, Y. H. (1999). 非免疫功能缺失病人合併巨細胞病毒大腸炎及志賀桿菌痢疾感染：一病例報告. 中華民國消化系醫學雜誌, 16(4), 283-289. https://doi.org/10.6557/GJTb.199912_16(4).0007
- Lin, Y. H., Lin, H. C., Chou, Y. H., Yang, S. Y., Jeng, C. H., Hung, H. Y., Hsieh, C. H., & Hung, W. C. (2009). 大腸直腸癌侵犯引發後腹腔壞死性筋膜炎－罕見案例報告. 中華民國整形外科醫學會雜誌, 18(4), 395-402. https://doi.org/10.7096/JPSA.200912.0395