経直腸的前立腺生検後に発症した敗血症

A case of septic shock and disseminated intravascular coagulation following transrectal prostate biopsy

　患者は57歳，男性。PSA高値のため当科に紹介された。前立腺生検前に浣腸を行い，LVFX 100mgを検査2時間前に，さらに，検査終了直後と6時間後にそれぞれ100mgを内服。生検翌日の晩より39℃台の発熱，血圧低下，尿量減少，血小板の著明な減少，FDPの増加を認め，敗血症によるDIC，多臓器不全と診断した。動脈血より大腸菌が分離同定され，MEPM 1g/day，AZT 2g/dayを生検後5日目より投与し軽快した。

A 57-year-old man with elevated PSA underwent transrectal sextant biopsy of the prostate. The patient was treated by enema and medicated LVFX 100mg one dose before and two doses after prostate biopsy. One day after,he suffered from spiked fever higher than 39℃,therefore was administered IPM/CS intravenously. Two days after,however the blood pressure dropped to 70/40mmHg with peripheral blood WBC 22,110/mm³,platelet 8.8×10⁴/mm³,creatinine 3.1mg/dl,GPT 214U/l. Under the diagnosis of DIC following the sepsis,anti-DIC drugs combined with antibiotics including FMOX,CLDM,PASPM/BP,CPFX,MINO,were given. Five days after,the blood culture revealed positive forE. coli,which was resistant to LVFX,and sensitive only to MEPM and AZT,which we used immediately,and he promptly recovered from DIC.