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要約 目的:眼窩蜂窩織炎は時に重篤な視機能障害を引き起こす急性化膿性炎症である。今回Panton-Valentine leukocidin(PVL)を産生するメチシリン耐性黄色ブドウ球菌(MRSA)による眼窩蜂窩織炎をわが国で初めて経験したため報告する。
症例:61歳,女性。右眼瞼腫脹,疼痛を主訴に香川大学医学部附属病院眼科へ紹介され受診した。初診時,右上眼瞼の高度の発赤腫脹,眼球結膜の充血と浮腫,眼球突出および眼球運動制限を認めた。また血液検査でC反応性蛋白および白血球の上昇,CTにて眼窩内炎症を疑う所見があり,眼窩蜂窩織炎として入院となった。眼脂培養にてPVLを産生するMRSAが検出されたため,抗MRSA薬およびカルバペネム系抗菌薬の点滴投与で加療したが反応は悪く,改善まで10日間を要した。
結論:PVLはMRSAが特徴的に産生する毒素で,白血球を特異的に障害し重症化しやすい。今回,PVL産生MRSAを起炎菌として健常者にもかかわらず重症化し,症状改善に時間を要した眼窩蜂窩織炎を経験した。難治な眼窩蜂窩織炎ではPVL産生菌の存在を念頭に置き,適切な抗菌薬の選択が必要である。
Abstract Purpose:Orbital cellulitis is an acute pyogenic inflammation that occasionally causes severe visual dysfunction. We report a case of orbital cellulitis caused by methicillin-resistant Staphylococcus aureus(MRSA), which produces Panton-Valentine leukocidin(PVL), a toxin specific to leukocytes.
Subject:A 61-year-old woman was referred to our hospital due to orbital cellulitis.
Observation:At initial examination, we observed severe swelling and rubefaction of the right upper eyelid, severe hyperemia and edema of the ocular conjunctiva, protrusion of the right eyeball, and ocular motor failure. Blood tests showed elevated white blood cell counts and C-reactive protein levels, and computed tomography findings indicated increased inflammation in the orbital lipid tissue, leading to a diagnosis of orbital cellulitis. We administered an intravenous carbapenem antibiotic drip and anti-MRSA antibiotics. Improvement was noted 10 days after treatment.
Conclusion:PVL is a leukocyte-specific toxin characteristically produced by MRSA and is associated with pathogenesis severity. We managed a case of severe orbital cellulitis caused by PVL-producing MRSA, which took a long time to resolve despite normal immunity. On suspecting the causative organism to be Staphylococcus aureus, we had to consider the possibility of PVL-producing MRSA and ensure appropriate antibiotic selection.
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