日和見菌による細菌性心外膜炎を発症した先天性低γグロブリン血症の1例

Congenital Immunodeficiency Syndrome with Bacterial Pericarditis Caused by Opportunistic Pathogen: A case report

　日和見菌であるStenotrophomonas maltophiliaによる細菌性心外膜炎を発症し，多量の心嚢液貯留を認めた先天性低γグロブリン血症の1例を経験した．本症例は免疫不全症候群による易感染性宿主であり，血液培養で慢性的にSte. maltophiliaが検出されていたため，血行感染により心外膜炎が発症したものと考えられた．同菌に対して良好な感受性が確認された硫酸ゲンタマイシンの全身投与を施行したが，心嚢液の貯留は抑制できなかった．このため，硫酸ゲンタマイシンの心嚢内への局所投与を施行したところ，約2ヵ月の経過観察において心嚢液の明らかな増加を認めなかった．抗生物質の心嚢内投与が有効であったと判断されたため，報告する．

　A case was reported of congenital immunodeficiency syndrome who suffered from bacterial pericarditis caused by Stenotrophomonas mattophilia (Ste. maltophilia) with marked pericardial effusion. Because of his immunodeficiency condition, he was suspected of being a compromised host. Ste. maltophilia existed chronically in his blood culture, so the pericarditis was probably caused by this bacterial infection which was translocated via blood. Gentamicin sulfate showed good sensitivity to the Ste. maltophilia, so we administered it intravenously. However, marked pericardial effusion showed up again a week after the puncture was made, so we administered gentamicin sulfate directly into the pericardial space and the increase in pericardial effusion was well suppressed by two months afterwards. Local gentamicin sulfate administration into the pericardial space was effective without serious side effects.