Klebsiella pneumoniae 간농양에 합병된 패혈성 전이 병변
Septic Metastatic Lesions Associated with Klebsiella pneumoniae Liver Abscess
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초록
Klebsiella pneumoniae 화농성 간농양은 최근 그 빈도가 증가하고 있으며 특징적인 임상양상으로 전신전이 합병증을 잘 일으키는 것으로 알려져 있으며 대부분이 당뇨와 같은 위험인자를 동반한 경우에 잘 발생된다. 저자들은 선행 질환이 없던 건강한 환자에게서 발생한 K. pneumoniae 화농성 간농양과 이에 병발된 패혈성 전이 병변에 의한 양측 안내염, 뇌수막염 및 척추염을 동반한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Pyogenic liver abscess is a serious clinical disease with severe complication in about 10-20% of cases. Metastatic septic endophthalmitis and CNS infection are rare but their incidence is increasing in liver abscess patients, especially Klebsiella pneumoniae as etiologic bacteria. Despite appropriate treatment, the outcome is devastating. We experienced a case of septic endophthalmitis, CNS infection (meninigitis, ventriculitis) and infective spondylitis associated with K. pneumoniae liver abscess. The patient had no specific risk factor. After intensive treatement such as systemic intravenous antibiotics with percutaneous abscess drainage and intravitreal injection, liver abscess was resolved completely. But, sequelae were severe. Socket reconstruction after evisceration with debridement on both eye and ventriculo-peritoneal shunt due to hydrocephalus were done. Our experience suggests that attention should be paid to the possibility of septic metastatic lesions as soon as the treatment of K. pneumoniae liver abscess is initiated.
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