日本救急医学会雑誌
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
劇症型A群β溶連菌感染症の救命にMRIと術中迅速病理診断を用いた1症例
久保田 信彦松田 直之近井 佳奈子伊藤 智雄千葉 仁志亀上 隆丸藤 哲
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2004 年 15 巻 10 号 p. 563-568

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A 33-year-old man was admitted to our emergency room with tachycardia and hypotension. Diffuse swelling, extensive blistering were noted in the body region extending from the left thigh to the left scrotum. Laboratory data revealed severe metabolic acidosis with an elevated anion gap and high lactate level, leukocytosis and renal dysfunction. Bacteriological examination of the exudate obtained from the blisters revealed numerous Gram-positive cocci. Although computed tomography revealed only swelling of the left thigh and scrotum, MRI, which was performed when the patient was clinically stable at the previous hospital, clearly suggested extensive myofascitis of the left thigh. An emergency debridement of the infected wounds was carried out, and intraoperative histopathological diagnosis guided the area of debridment. The resected tissues from the left thigh and scrotum revealed widespread necrosis and large numbers of Gram-positive cocci, which were identified as Group A β-hemolytic streptococci. In this case report, we show that MRI and intraoperative histopathological examination are more effective than computed tomography for the early diagnosis of TSLS.

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