Vibrio vulnificusによる壊死性筋膜炎

・夏場の潮干狩りでVibrio vulnificus（以下V. vulnificus）による壊死性筋膜炎を生じた症例を経験した．死亡率が高いが，救命しえた．

・既往歴にアルコール性肝障害があった．

・早期に皮膚切開とデブリードマンを施行し，empiric therapyとしてメロペネム，クリンダマイシンで抗菌薬投与を開始したところ炎症反応が改善した．

・エンドトキシンによる多臓器不全に対し，エンドトキシン吸着療法（PMX-DHP）を行ったところ，予後が改善された．

（「症例のポイント」より）

　

Necrotizing fasciitis by Vibrio vulnificus infection

　

Hidaka, Yuri1）Mitsuma, Teruyuki1）Murakami, Megumi1）Ueno, Erika1）Mizuta, Miyuki1）Aiyama, Akiteru1） 1）Department of Dermatology, Ichinomiya Municipal Hospital Abstract

　

A 70 years old man with alcoholic liver disease was admitted to our hospital with high fever, depression in blood pressure, general fatigue, and eruption in the lower left leg. He went to get the shellfish on the coast of Aichi prefecture a few days before onset. We took antibiotics immediately, and excised necrotizing tissue in the left leg. Vibrio vulnificus was isolated from a blood culture performed. Then, endotoxin absorption therapy was performed, which successfully saved the patient’s life. In order to prevent this type of fatal infection, it is necessary for medical staffs and patients who have liver disease, diabetes and immune deficiency to make the better understandings of its clinical characteristics.