Aggregatibacter aphrophilus 심내막염에서 발생한 패혈성 하지 동맥 색전증 1예
Septic Peripheral Embolism in Left Leg from Aggregatibacter aphrophilus Endocarditis
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Aggregatibacter aphrophilus는 통성 혐기성 그람음성 짧은막대균 혹은 막대균으로 증식 시 X인자를 요구하지 않고 V인자에 다양한 요구도를 갖는 특징을 가지고 있다. 구강 및 상기도 정상 균무리로 드물게 균혈증, 심내막염, 뇌농양, 골수염등의 감염을 일으키는 것으로 알려져 있다. 저자들은 A. aphrophilus 심내막염에서 발생한 패혈성 하지동맥 색전증 1예를보고하는 바이다. 6개월 전 고혈압을 진단 받은 49세 남자 환자가 내원 당일 갑자기 발생한 왼쪽 다리 통증을 주소로내원하였다. 이학적 검사상 심음은 규칙적이었으나 범수축기 잡음이 청진되었으며 양측 하지 검사에서 운동 및 감각은정상이었으나 좌측 슬와동맥과 발등동맥의 맥박이 약하게 촉지되었으며 발에 냉감이 있었다. 혈관조영술상 왼쪽 대퇴동맥의 분지에 색전성 폐색이 관찰되어 응급 색전제거술을 시행받았으며 적출된 색전 배양에서 그람음성 막대균이 증식하였다. 같은 날 실시한 2쌍의 혈액배양에서도 동일 균이 증식하였고 이 균은 A. aphrophilus로 최종 동정되었다. 말초 동맥색전증 원인을 찾기 위해 실시한 경흉부심초음파상 승모판에 다발성 증식물 및 승모판 역류가 관찰되어 감염성 심내막염 및 패혈성 하지동맥 색전증 진단하에 4주간 3세대 cephalosporin을 투여하였고 승모판막 치환술 후 퇴원하였다.
Abstract
Aggregatibacter aphrophilus is a facultatively anaerobic gram-negative coccobacillus or bacillus that grows with no dependence on X factor and variable requirement for V factor. The organism is normal flora in the human oral cavity and upper respiratory tract and, rarely, causes invasive infections such as bacteremia, endocarditis, brain abscess, or osteomyelitis. We report a case of septic peripheral embolism in left leg from A. aphrophilus endocarditis. A 49-year-old man with known hypertension presented with acute muscle pain in the left leg. On physical examination, a regular heartbeat with a pansystolic murmur was heard. There were decreased pulses in the left popliteal and dorsalis pedis arteries and coldness of the left foot, although sensory and motor functions were intact. Angiography revealed an embolus in a branch of the left femoral artery. He underwent emergency embolectomy, and gram-negative bacilli grew in the embolus cultures. The same microorganism was isolated in two pairs of blood culturs and subsequently identified as A. aphrophilus. Transthoracic echocardiography revealed mitral regurgitation and multiple vegetations on the mitral valve. The patient was treated with a third-generation cephalosporin for 4 weeks and mitral valve replacement in view of the diagnosis of infective endocarditis and septic peripheral embolism.
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