G群溶連菌による壊死性筋膜炎の1例

Necrotizing Fasciitis Caused by Group G Streptococcus. Case Report

　症例は78歳の男で，前立腺癌，骨転移を有する．発熱および左下肢の発赤腫脹で受診した．左下腿に皮膚の壊死を伴い切開により漿液性の米のとぎ汁様の膿汁が多量に排出した．培養でG群溶連菌が検出された．局所のデブリドマンおよびペニシリン系抗生剤とクリンダマイシンの投与で全身状態は改善した．G群溶連菌は従来，病原性が弱いとされてきたが，近年，易感染性宿主に対する重篤な感染症の報告が増加している．過去10年間のG群溶連菌による壊死性筋膜炎の本邦報告例の検討では，基礎疾患を有する患者や高齢者に多く，致死率は28.5％と高率であった．

　We report a case of necrotizing fasciitis caused by group G streptococci.　A 78-year-old man with prostate cancer and bone metastasis complained of swelling and redness of the left leg and a high fever.　Physical examination revealed cutaneous necrosis on his left lower limb.　Incision of the necrotic skin yielded, large amounts of serous pus, and a culture grew out group G streptococci.　The patient was treated by local debridement and with penicillin and clindamycin.　His condition improved, and he was discharged from the hospital.　Group G streptococci used to be considered weak pathogens, but reports of severe infectious diseases caused by group G streptococci in compromised hosts have been increasing in recent years.　A search of the literature on necrotizing fasciitis caused by group G streptococci in Japan during the past ten years showed that most patients had complications or were elderly, and that the mortality rate was 28.5%.