Community-acquired methicillin-resistant Staphylococcus Aureus Bacteremia with Osteomyelitis and Pulmonary Emboli: A Case Report

社區型對methicillin具有抗藥性的金黃色葡萄球菌菌血症合併骨髓炎與肺栓塞：病例報告

陳怡真(I-Chen Chen) ； 林世雄(Shih-Hsiung Lin) ； 徐仲豪(Jong-Hau Hsu) ； 吳俊仁(Jiunn-Ren Wu) ； 戴任恭(Zen-Kong Dai)

《中華民國兒童胸腔醫學會雜誌》 5卷4期 (2008/08) Pp. 47-52

https://doi.org/10.6322/JPRD.200808_5(4).0007

摘要

敗血性肺栓塞並不常見，它的症狀大多是發燒，呼吸道症狀，或是肺部的浸潤。臨床或是影像醫學上的特徵通常不具有特異性，因此也導致了診斷的困難。我們提出一個12歲大的男童，因左腿蜂窩性組織炎今併高燒，兩天之後右肩膀關節疼痛與關節活動限制而住院。一開始並沒有任何呼吸道症狀，但胸部X光卻發現兩側肺有不規則的浸潤。核磁共振攝影發現有鎖骨的骨髓炎與附近組織的服性肌炎，此外，還有兩側肺部多發性的肺栓塞。我們及時將抗生素更改為萬古徽素。五天後，血液培養出具methicillin抗樂性的金黃色葡萄球菌(MRSA)，因此診斷為敗血性肺松塞。經過一個月的抗生素治療，無論是骨髓炎或是敗血性肺栓塞，都已緩解。臨床上，當懷疑有MRSA的成染峙，安排適當的影像檢查與血液培養可以及時偵側出無症狀的肺部感染，早期的發現與治療可以帶來較好的預後。

關鍵字

對methicillin具抗藥性的金黃色葡萄球菌菌血症 ； 敗血性肺栓塞 ； 骨髓炎 ； 膿性肌炎

並列摘要

Septic pulmonary embolism (SPE) is an uncommon disorder in children that generally presents with an insidious onset of fever, respiratory symptoms, and lung infiltrates. Clinical and radiologic features at presentation are usually nonspecific， and diagnosis of this disorder is frequently delayed. We report a previously healthy boy aged 12 years with high fever and left anterior tibial cellulitis. Two days later, pain in the right shoulder with limited neck rotation developed. On admission, he had no respiratory symptoms. Chest films revealed alveolar infiltrates in both middle lungs. Chest magnetic resonance imaging (MRI) revealed osteomyelitis, pyomyositis, and multiple nodular emboli in both lung fields. We immediately changed the antibiotic from cefazoline to vancomycin. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in blood culture 5 days later. One month after vancomycin therapy, neither osteomyelitis nor septic emboli in lung was noted in follow- up chest films and MRI. In this case, the asymptomatic pulmonary embolism was detected incidentally by chest MRI while osteomyelitis or pyomyositis was impressed. Early diagnosis of invasive MRSA and appropriate antibiotic treatment can lead to a good outcome.

並列關鍵字

Methicillin-resistant staphylococcus aureus bacteremia MRSA abcteremia ； septic pulmonary emboli ； osteomyelitis ； pyomyositis