糖尿病患跌倒後骨折併化膿性肌炎及新診斷大腸癌個案報告

68歲糖尿病女性在跌倒四天後就醫。急診診斷右股骨頸骨折。實驗室檢查顯示：白血球19,800/uL（band: 1%, Seg: 90%）、血紅素4.3 g/dL,，肌酸酐2.11 mg/dL，小便鏡檢白血球20-29/HP。個案有敗血症併泌尿道感染和嚴重貧血等問題，由高齡醫學科收治住院，由高齡多專業團隊與骨科醫師共同照護。周全性評估顯示個案為高跌倒風險合併體重下降營養問題，身體功能骨折後急性下降。因此，團隊物理治療師早期復健介入，維持肌力與移位訓練，同時，營養師介入飲食衛教均衡飲食。住院期間因缺鐵性貧血，給予血液輸注和口服鐵劑補充。腹部電腦斷層顯示5.4公分的乙狀結腸腫瘤合併輸尿管侵犯與肝臟轉移，以及右側股骨頸骨折合併髂肌多處肌肉內膿瘍。尿液、血液、以及髂肌膿瘍培養菌種均為Klebsiella pneumoniae，診斷為菌血症合併化膿性肌炎與泌尿道感染。經膿瘍抽吸和抗生素治療兩周後仍發燒，進一步安排骨科清創與髖關節切除成型術（Girdlestone procedure with cemented austin-moore spacer），術後個案右側大腿水腫消除，可開始練習站立。持續靜脈注射抗生素治療滿一個月後，轉大腸直腸外科安排手術腫瘤切除治療。

關鍵字

化膿性肌炎；糖尿病；跌倒；貧血；骨折

並列摘要

A 68-year-old diabetic woman visited the hospital four days after a fall. An X-ray film shot at the emergency room showed a right femoral neck fracture. The lab data included white cell count: 19,800/u (band: 1%, Seg: 90%), hemoglobin: 4.3 g/dL, creatine: 2.11 mg/dL and urine white cell count: 20-29/HP. Urosepsis, acute renal injury, and severe anemia were noted. Thus, she was admitted to the geriatric ward. After admission, iron deficiency anemia was diagnosed. Blood transfusion and oral iron supply were given to her. An abdominal computed tomography scan revealed a 5.4-centimeter sigmoid colon cancer combined with left ureter invasive, liver metastasis, left hydronephrosis, and right femoral neck fracture with multiple intramuscular abscesses of iliacus muscle. The culture of her urine, blood, and abscess grew Klebsiella pneumonia. Bacteremia combined with pyomyositis and Urinary tract infection were diagnosed. After aspirating abscesses and treating with antibiotics for two weeks, her fever persisted. Thus, she received Girdlestone procedure with cemented Austin-moore spacer and debridement. Then, her general symptoms improved, and she started rehabilitation. After being treated with intravenous antibiotics for 4 weeks, she was transferred to the colorectal surgery ward for the sigmoid colon cancer resection preparation.

並列關鍵字

pyomyositis ； diabetes ； fall ； anemia ； fracture

延伸閱讀

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
Weng, M. W., Tsai, W. C., Chen, H. P., & Lin, T. C. (2005). 尿毒症病人合併大腸桿菌感染細菌性肩關節炎：一病例討論. 內科學誌, 16(5), 241-245. https://doi.org/10.6314/JIMT.2005.16(5).06
蘇家龍、蔡崇煌、廖重佳（2016）。右側髂腰肌膿瘍合併糖尿病酮酸中毒個案報告。家庭醫學與基層醫療，31(2)，52-58。https://www.airitilibrary.com/Article/Detail?DocID=P20090727001-201602-201603030019-201603030019-52-58
Chang, M. L., & Lin, H. C. (2006). Spontaneous Closure of Tracheal Fistula caused by Descending Necrotizing Mediastinitis in a Diabetic Patient-A Case Report and Review of the Literature. 胸腔醫學, 21(1), 75-81. https://doi.org/10.29806/TM.200602.0012
Chen, S. M., Lin, K. Y., Tsai, T. Y., Wu, C. C., & Lin, L. C. (2011). Metastatic Bone Disease with Pathologic Fracture of the Femoral Neck: Bone Scintigraphic Detection of Occult Lesion in a Case with Minimal Findings on Plain Radiography. Journal of Medical Sciences, 31(4), 185-189. https://doi.org/10.6136/JMS.2011.31(4).185

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糖尿病患跌倒後骨折併化膿性肌炎及新診斷大腸癌個案報告

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