Fusobacterium Nucleatum Infection Manifesting as Simultaneous Psoas Muscle and Lung Abscesses: Report of a Case

腰肌膿瘍合併快速生長的梭桿菌肺膿瘍－病例報告

黃漢笙(Han-Sheng Huang) ； 沈光漢(Gwan-Han Shen) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 28卷4期 (2013/08) Pp. 215-221

摘要

肺膿瘍通常起因於吸入性肺炎後導致肺實質壞死。口咽部厭氧菌是最常見的吸入性病原菌，然而在台灣，社區感染的肺膿瘍其細菌種類並不相同，克雷伯氏肺炎桿菌已成為最常見的細菌。我們報導一個59歲男性一開始以下背痛六個月為表現，胸腔X光和腹部電腦斷層顯示三日內快速擴大的肺膿瘍和腰肌膿瘍。肺部抽吸培養結果為具核梭桿菌，符合病人牙周病的病史，但並非腰肌膿瘍常見的病原菌。此病人並無機械性吞嚥缺陷或免疫功能不全的情況。我們一開始使用靜脈注射Flomoxef作為經驗性抗生素，並依據藥敏試驗以靜脈注射Amoxicillin/Clavulanic acid 接替使用。以胸腔X 光和胸腔電腦斷層追蹤，顯示肺膿瘍和腰肌膿瘍皆有改善，病人於開立口服Amoxicillin/Clavulanic acid後出院繼續藥物治療，門診胸腔X光追蹤顯示肺膿瘍完全消退。

關鍵字

肺膿瘍 ； 腰肌膿瘍 ； 厭氧菌 ； 牙周病 ； 具核梭桿菌

並列摘要

Lung abscess is usually initiated by aspiration pneumonia and results from necrosis of pulmonary parenchyma. The most commonly aspirated pathogens are anaerobes from the oropharyngeal cavity. However, the bacteriology of community-acquired lung abscess (CALA) is different in present-day Taiwan. Klebsiella pneumoniae is now the most commonly isolated pathogen in CALA. We reported a 59-year-old man who had an initial presentation of back pain for 6 months. A rapidly growing lung abscess within 3 days and a psoas muscle abscess were revealed on chest X-ray and abdominal computed tomography (CT) scan. The lung aspirate culture yielded Fusobacterium nucleatum, corresponding to the patient's history of periodontitis, but this pathogen is not commonly seen in psoas muscle abscess. The patient did not have an impaired swallowing mechanical defect or immunocompromised status. Empirical treatment with intravenous Flomoxef was used initially, and then intravenous amoxicillin/clavulanic acid was started based on the drug sensitivity test. The follow-up chest X-ray and chest CT scan revealed improvements in the lung and psoas muscle abscesses during hospitalization. The patient was prescribed a course of oral amoxicillin/clavulanic acid and was discharged home. The lung abscess had resolved completely on chest X-ray when the patient visited the hospital outpatient department.

並列關鍵字

lung abscess ； psoas muscle abscess ； anaerobes ； periodontitis ； Fusobacterium nucleatum