アトピー性皮膚炎合併の気胸患者に対する胸腔ドレナージ中に急性膿胸を発症した1例

Acute Empyema During Thoracic Drainage in a Pneumothorax Patient with Atopic Dermatitis：Report of a Case

はじめに　自然気胸は若年男性に多くみられ，胸腔ドレナージを要することも少なくない．一方，アトピー性皮膚炎の成人男性における有病率も5％程度と頻度の高い疾患である．われわれはアトピー性皮膚炎患者の右自然気胸に対して胸腔ドレナージを行い，早期に急性膿胸を発症した症例を経験したため報告する．

A 33-year-old man with atopic dermatitis underwent thoracic drainage was initiated for the right spontaneous pneumothorax. On the third hospital day, he developed acute empyema with pleural fluid opacity and elevated inflammatory reaction on blood test. For prolonged air leakage and acute empyema, thoracoscopic bullectomy and thoracic lavage and curettage were performed on the 6th hospital day. Because the preoperative cultural test of pleural effusion showed meticillin-resistant Staphylococcus aureus （MRSA）, he was treated with vancomycin and ampicillin/sulbactam, and discharged on the 11th hospital day （the 5th postoperative day）. Although spontaneous pneumothorax is rarely associated with empyema, patients with atopic dermatitis are prone to infections caused by Staphylococcus aureus, and the relation between atopic dermatitis and empyema was suspected in this case. As percutaneous medical procedures pose a risk of deep bacterial infection, when medical procedures including thoracic drainage is performed for patients with dermatosis, it is important to keep the possibility of bacterial infection in mind, and to quickly shift to treatment by detecting early signs of infection.