感染性心内膜炎などの反復する菌血症にアトピー性皮膚炎が関与したと考えられた1例

Infective Endocarditis Associated with Atopic Dermatitis

　34歳，男性．幼少時よりアトピー性皮膚炎，32歳の時，肝膿瘍の既往あり．今回入院前には抜歯など観血的処置の既往なし．40℃の発熱，全身倦怠感，筋肉痛にて発症．両側足底のJaneway皮疹より感染性心内膜炎を疑われ，心臓超音波検査にて僧帽弁後尖に疣贅を認めた．血液培養では黄色ブドウ球菌を検出し感染性心内膜炎と診断した．セファゾリン，バンコマイシンの投与にて解熱，疣贅の縮小，炎症所見の消失をみた．後日施行した皮膚擦過培養でも黄色ブドウ球菌が検出された．健常者に比し，アトピー性皮膚炎患者の皮膚培養からは高率に黄色ブドウ球菌が検出されるといわれている．本例では過去に黄色ブドウ球菌の関連した肝膿瘍の既往を有することより，擦過により皮膚に存在する黄色ブドウ球菌が血液内に入ることで，容易に菌血症を生じ，感染性心内膜炎を発症したものと推定された．アトピー性皮膚炎患者では観血的な処置が先行しなくても菌血症から感染性心内膜炎を発症する可能性があり注意が必要である．

A 34 year-old man witn a mstory at severe atopic dermatitis from infancy was admitted to the local hospi tal with the complaints of high fever, general fatigue and muscle pain. There was a Janeway lesion on the soles of his feet. An echocardiogram showed large vegetation on the postero-medial commisure of the mitral valve. The blood culture test demonstrated Sta phylococcus aureus, and the patient was diagnosed m having infective endocarditis. The patient was effectively treated with cefazoline (6.0 g/day) and van comycin (1.0-2.0 g/day) for 38 days. and the extent of vegetation was shown by echocardiography to be smal- ler than it was before treatment. Colonization of Sta phylococcus aureus is commonly observed in skin lesions of atopic dermatitis, and its incidence is significantly higher in patients with atopic dermatitis than in healthy individuals. Actually, Staphylococcus aureus was found it several skin lesions of the present patient. As is fount also in the history of liver abscess, the presence of atopic dermatitis may be closely related to the occurrence of infective endocarditis in this patient. We would suggest that careful observation is necessary when atopic der matitis is accompanied by the presence of Staphylococcus aureus, even though the patient has no history of Organic heart disease.