敗血症性ショック，多発感染病巣を来した肝膿瘍を伴わない侵襲性過粘稠性クレブシエラ感染症の1例(Hypermucoviscous invasive Klebsiella pneumoniae syndrome without liver abscess with septic shock and multiple infection: a case report)

• Published in: Nihon Kyūkyū Igakkai zasshi 2020-02, Vol.31 (2), p.53-58
• Main Authors: (Kunie Suzuki), 鈴木 邦恵, (Nozomi Ozaki), 尾崎 望, (Shinsuke Endo), 遠藤 真佑, (Naho Ishigame), 石亀 那歩, (Nobuhiro Sato), 佐藤 信宏, (Toshiharu Tanaka), 田中 敏春, (Yasuo Hirose), 廣瀬 保夫
• Format: Article
• Language: English
• Subjects: iliopsoas abscess; invasive liver abscess syndrome; pyogenic spondylitis; string test; urinary tract infection; 侵襲性肝膿瘍症候群; 化膿性椎体炎; 尿路感染症; 腸腰筋膿瘍
• ISSN: 1883-3772; 1883-3772
• DOI: 10.1002/jja2.12426

要旨 　過粘稠性K. pneumoniaeによる尿路感染から敗血症性ショック，全身に多発感染病巣を呈した1症例を経験したため報告する。症例は70歳代の女性。血圧低下のため当院に搬送された。精査の結果，尿路感染に伴う敗血症性ショックの診断で輸液，昇圧剤とmeropenemでの治療を開始した。血液培養でstring test陽性の過粘稠性Klebsiella pneumoniae感染と判明した。腸腰筋膿瘍と化膿性椎体炎を合併したが，肝膿瘍は認めなかった。腸腰筋膿瘍と化膿性椎体炎に対しデブリードマン，椎間板掻把術を施行し，7週間の抗菌薬治療後にリハビリ目的に転院した。遺伝子分析では，mag A（K1 serotype），rmp A 陽性の過粘稠性クレブシエラが同定された。過粘稠性K. pneumoniaeによる肝膿瘍から全身に多発膿瘍を来す侵襲性肝膿瘍症候群は，1980年代より東アジアを中心に報告がみられる。呈示例では肝膿瘍を認めず，ショック，多発膿瘍を呈した。K. pneumoniae感染症において感受性良好な抗菌薬治療にも関わらず難治な経過を呈する場合，肝膿瘍を呈さずとも過粘稠性K. pneumoniae感染を想定することが重要である。 ABSTRACT We herein describe a case of urinary tract infection with septic shock and systemic infection caused by hypermucoviscous Klebsiella pneumoniae. A woman in her 70s was transferred to our hospital with hypotension. She was treated with fluid resuscitation, vasopressors, and meropenem. Klebsiella pneumoniae was cultured from her blood, and a string test was positive. She developed an iliopsoas abscess with subsequent pyogenic spondylitis; however, her condition was not complicated by a liver abscess. The patient underwent surgical debridement and drainage of the iliopsoas abscess and pyogenic spondylitis, began a 7–week course of antibiotic treatment, and was transferred to a rehabilitation hospital. The genotype of the causative strain was mag A (K1 serotype) and rmp A. Invasive liver abscess syndrome caused by hypermucoviscous K. pneumoniae, characterized by liver abscesses and systemic metastatic infection, was first reported in East Asia after the 1980s. Our patient developed septic shock and multiple infections despite the absence of a liver abscess. Hypermucoviscous K. pneumoniae infection should be considered in patients with multiple organ abscesses that are intractable to treatment with appropriate antibiotics, even if not complicated by liver abscesses.