류마티스 관절염 환자에서 발생한 Mycobacterium abscessus에 의한 패혈증 1예
A Case of Sepsis by Mycobacterium abscessus in a Patient with Rheumatoid Arthritis
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Mycobacterium abscessus는 신속 발육균 비결핵성 미코박테리아이며, 흔히 피부와 연부조직 감염을 일으키나 면역 저하환자에서는 다발성 혹은 전신성 감염이 발생할 수 있다. 류마티스 관절염 진단 후 스테로이드를 임의로 복용하던 환자가 양손과 발에 발적과 부종이 발생하여 개인병원에서 치료받던 중 혈압이 저하되어 본원으로 전원되었다. 혈액, 소변, 농양, 발목 관절액에서 시행한 배양검사에서 M. abscessus가 배양되었고, 항결핵균제 감수성검사 결과 등을 고려하여 clarithromycin, kanamycin, ciprofloxacin 치료 후 clarithrymycin, kanamycin에 pyrazinamide를 추가하여 사용하였다. 투약 후 전신상태가 많이 호전된 상태로 clarithromycin과 pyrazinamide로 유지하며 퇴원하여 외래에서 치료 중이다. M. abscessus는 감염을 일으키는 경우가 드물기 때문에 진단이 어렵고, 종마다 항균제에 대한 감수성이 다르므로, 정확한 균 동정이 치료에 필수적이다. 저자들은 류마티스 관절염 진단 후 스테로이드를 임의로 복용하던 환자에서 발생한 파종성 M. abscessus 감염 및 패혈증을 경험하였기에 보고한다.
Abstract
Mycobacterium abscessus is a rapid growing pathogenic nontuberculous mycobacterium, which causes systemic disseminated infections as well as localized infections such as skin and soft tissue infections. We experienced a case of M. abscessus sepsis secondary to septic arthritis, osteomyelitis, and cellulitis in a rheumatoid arthritis patient. A 68-year old female with rheumatoid arthritis developed skin and soft tissue infections in upper and lower extremities. Acid fast bacilli were identified from the pus smear of hand. While receiving anti-tuberculosis medication, M. abscessus was identified in blood culture, pus from hand, synovial fluid of foot, and urine. With surgical debridement and medications containing clarithromycin, her condition gradually improved and was discharged.
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