肩関節離断術により救命し得た壊死性筋膜炎を伴う劇症型A群溶血性連鎖球菌感染症の1例

Survival of a Patient with Streptococcal Toxic Shock-like Syndrome with Necrotizing Fasciitis Treated by Disarticulation of the Infected Limb at the Shoulder. Case Report

　上肢発症の壊死性筋膜炎を伴う劇症型A群溶血性連鎖球菌感染症の1例を経験したので報告する．症例は52歳の男性で，既往症に慢性B型肝炎と慢性ネフローゼ症候群があった．右母指に小さな挫創を受傷した3日後にショック状態で救急搬送された．壊死性筋膜炎の疑いで直ちに抗ショック療法と抗生剤大量療法を行ったが，病状は時間単位で急激に進行した．搬送から4時間30分後，救命のため肩関節離断術を行った．受傷部位の穿刺液の培養でA群溶連菌が検出された．本症の治療には迅速な診断と切断術も含めた早期外科的治療が重要である．

　We report a case of streptococcal toxic shock-like syndrome (STSS) with necrotizing fasciitis of the upper extremity.　A 52-year-old man who had chronic hepatitis B and the nephrotis syndrome sustained a minor laceration of his right thumb, and three days later he was admitted to another hospital because of severe pain in the thenar eminence.　In the evening of the same day he lapsed into shock and was brought to our emergency center.　On arrival, his right thenar eminence was swollen and red, and the patient complained of severe pain.　Suspecting necrotizing fasciitis, we immediately instituted anti-shock therapy and administered intravenously high-dose antibiotics in, but his condition rapidly deteriorated.　Finally, four hours after arrival, the patient's right upper limb was disarticulated at the shoulder to save his life.　Group A Streptococcus pyogenes was isolated from cultures of wound aspirates.　STSS is a life-threatening bacterial infection.　A favorable prognosis depends on early diagnosis and immediate surgical intervention.