化学療法後にガス壊疽菌敗血症を合併したα-fetoprotein高値胃癌の1例

抄録

An 81-year-old man visited our hospital because of loss of appitite and general fatigue. A panendoscopic examination revealed a round ulcerated lesion on the posterior wall of the gastric antrum and a pathological examination of the biopsied specimen showed a poorly differentiated adenocarcinoma. Since multiple liver tumors were detected by an abdominal CT scan and an elevated value of serum AFP, 273ng/ml, was noticed, a liver tumor biopsy was done after admission. As it was the same histology as that of the gastric carcinoma, an AFP producing gastric carcinoma with liver metastasis was highly suspected.
Ten units of OK-432 and 250mg of 5-furuolouracil (5-FU) were injected concomitantly at the site of the gastric carcinoma through a fine needle via a panendoscopy twice with a week's interval. Ten days after the local injection, 750mg of 5-FU and 120mg of methotrexete were given intravenously. On that day the patient suddenly exhibited a fever, a chill, jaundice and hematuria. The next day he died of disceminated intervascular coagulation and multiple organ failure.
At the autopsy, a lot of odorous gas was retained intraperitoneum and subcutaneously. There were multiple cavities in the organs such as the liver, kidney, heart and so on. A microscopic examination showed multiple rod shaped organisms on the sides of the cavities and in the vein. All these findings indicated the sepsis of gas producing organisms.