アトピー性皮膚炎を基礎疾患とし肺動脈弁感染性心内膜炎を発症した1例(A case of isolated pulmonary valve infective endocarditis with atopic dermatitis)

• Published in: Nihon Kyūkyū Igakkai zasshi 2023-04, Vol.34 (4), p.127-132
• Main Authors: 祐司, 野田, 賢彦, 海田, 知明, 根田, 晃康, 大津, 慧, 吉川, 剛明, 松田, 芳裕, 山口
• Format: Article
• Language: English
• Subjects: hand sanitizer; sepsis; Staphylococcus aureus; 手指消毒; 敗血症; 黄色ブドウ球菌
• ISSN: 1883-3772; 1883-3772
• DOI: 10.1002/jja2.12801

要旨 　アトピー性皮膚炎（atopic dermatitis: AD）は慢性皮膚炎であり，感染性心内膜炎（infective endocarditis: IE）など重症感染症の合併報告はコントロール不良なAD例であり，さらに肺動脈弁の孤立性IE報告例はない。症例は50歳代の男性，既往はコントロール良好な小児期からのADあり。手指消毒剤により指尖部乾燥が増悪していた。入院5日前に発熱し近医から抗菌薬を処方されたが，入院前日に体動困難となり他院へ搬送され敗血症の診断で入院した。翌日精査加療目的に当院へ転院した。来院時意識清明，呼吸循環動態は保たれていたが，40℃の発熱と右肘の発赤腫脹，前腕の有痛性浮腫性紅斑を認めた。血液検査で血小板が3.6万に低下しており敗血症と診断し広域抗菌薬を投与し救命センターに入室とした。入院後右肘穿刺液，左前腕筋間の膿瘍，血液培養からメチシリン感受性ブドウ球菌が検出されセファゾリンにて治療を継続した。入院15日目まで複数回の経胸壁・食道心臓超音波検査とCT検査では疣贅を認めず，ガリウムシンチグラフィーでも有意な所見を認めなかったが，入院33日目に施行した造影CT検査にて肺動脈弁の疣贅を確認した。血液培養陰性化後6週間抗菌薬を投与し，入院51日目に退院した。ADの既往のある菌血症症例は肺動脈弁領域のIEの可能性も念頭に繰り返し評価し考慮する必要がある。 ABSTRACT Atopic dermatitis (AD) is a common chronic dermatitis, and severe infectious diseases triggered by AD have been reported. We describe a 58–year–old Japanese male with AD who developed pulmonary–valve infective endocarditis. The dryness of his fingertips had been exacerbated by hand sanitizer. Five days before his admission, he had a fever and was prescribed antibiotics. Two days before admission, he was admitted to a general hospital but was then transferred to our hospital for treatment. On admission, he had a fever of 40℃ and painful edematous erythema of his forearm, but his respiratory and circulatory dynamics were maintained. Platelets had dropped to 36,000, and sepsis was diagnosed. Methicillin–sensitive staphylococci were detected in the right elbow’s fluid and blood culture, and we changed the antibiotics to cefazolin. Enhanced CAT scanning and cardiac ultrasound showed no abnormalities until the 15th day of hospitalization. On the 33rd day of hospitalization, vegetation of the pulmonary valve was confirmed. Antibiotics were administered for 6 weeks, and the patient recovered. Clinicians should be aware that patients with a history of AD may develop serious infections even if their AD is well controlled.