顎顔面部非クロストリジウム性ガス壊疽の1例

抄録

An 83-year-old man was referred to our department because of severe facial pain on September 19, 2001. He had had continuous dull pain in the right cheek for 3 weeks and was prescribed antibiotics by an otolaryngologist 1 week before presentation. Despite treatment, progressive pain and swelling did not resolve. Physical examination revealed a tender, nonfluctuant swelling in the middle of the right side of the face and the submandibular and temporal regions. The patient had only 2 teeth in the upper right side of the maxilla. These teeth were slightly tender on percussion. The body temperature was 37.7°C. Blood tests revealed leukocytosis of 22700/μ1, a C-reactive protein level of 33.6mg/dl, and a glucose level of 142 mg/dl. Reexamination showed a free blood sugar level of 116 mg/dl and HbA 1 C of 5.2%. Computed tomography revealed extensive accumulation of gas bubbles in multiple spaces of the maxillofacial region. Intravenous administration of antibiotics was immediately initiated, and 3 incisions were made: 1 in the right side of the neck and 2 in the temporal region. A large amount of foul-smelling purulent material was drained. Gram-stain smears indicated mixed infection with gram-positive cocci and gram-negative rods. The culture revealed the presence of Staphylococcus and Fusobactenum, but not Clostridium. On the basis of these findings, a final diagnosis of non-clostridial gas gangrene was made.