Klebsiella pneumoniae에 의한 심낭 압전으로 진행된 급성 화농성 간농양 1예
A Case of Pyogenic Liver Abscess Complicating Cardiac Tamponade Caused by Klebsiella pneumoniae
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83세 여자 환자가 발열과 복부 통증 심한 호흡곤란을 주소로 내원하였다. 불안정한 생체증후를 보였으며 심초음파검사상 급성 심낭염과 심낭 압전 소견을 보여 심낭 천자 및배액술을 시행하였고 탁한 화농성 심낭액이 배출되었다. 간농양과 급성 심낭 압전으로 입원하여서 대한 경피적 배액을시행과 항생제 투여하면서 경과관찰하였다. 심낭 삼출액 배양 검사와 배양된 간농양에서 Klebsiella pneumonia가 동정되었다. 이후 3주간 항생제 투여하며 증세 호전되어 퇴원 후현재 경과관찰 중이다. 화농성 심낭염과 심낭 삼출은 간농양의 드문 합병증으로 주로 농양과 심낭 사이에 누공이 존재한 경우나 아메바에 의한 경우가 드물게 보고되었으며 본증례처럼 Klebsiella penumoniae에 의해 간농양이 선행되어서진행된 급성 화농성 심낭염과 이로 인한 심낭 압전의 예는보고된 적이 없다. 이에 본 저자들은 간농양이 선행되어서발생한 Klebsiella pneumoniae에 의한 급성 화농성 심낭염과심낭 압전을 경험하고 치료하였기에 이를 문헌고찰과 함께보고하는 바이다.
Abstract
An 83-year-old female patient visited the emergency department for abdominal pain and dyspnea with hemodynamic instability. Abdominal computed tomography showed multiple liver abscesses and a large volume of pericardial effusion. A transthoracic echocardiography revealed features suggestive of cardiac tamponade, including massive pericardial effusion and diastolic collapse of the right atrial wall. Emergency percutaneous pericardial drainage and percutaneous transhepatic drainage were performed. Klebsiella pneumoniae (KP) was isolated from both the pericardial effusion and bile. The first case of cardiac tamponade secondary to a liver abscess in Korea was reported in 1981, and it was caused by amoebal infection via fistula formation between the pericardium and abscess. We recently experienced a case of pyogenic liver abscess caused by KP complicating cardiac tamponade via direct invasion. This is an unusual complication of KP infection because KP is more frequently associated with hematogenous spread.
참고문헌 (10)
- Liu YC, "Klebsiella pneumoniae liver abscess associated with septic endophthalmitis", Arch Intern Med, 146, pp.1913~1916 (1986)
- Choi HS, "A case of large bile duct stones complicated by pyogenic pericarditis, liver abscess, and pyothorax", Korean J Gastrointest Endosc, 14, pp.380~385 (1995)
- Park BI, "Clinical studies on acute pericarditis with effusion and chronic constrictive pericarditis with or without effusion", Korean Circ J, 8, pp.1~8 (1978)
- Kauffman CA, "Purulent pneumococcal pericarditis : a continuing problem in the antibiotic era", Am J Med, 54, pp.743~750 (1973)
- Brook I, "Microbiology of acute purulent pericarditis : a 12-year experience in a military hospital", Arch Intern Med, 156, pp.1857~1860 (1996)
- Vong SC, "Cardiac tamponade secondary to pyogenic liver abscess", J Clin Gastroenterol, 41, pp.635~636 (2007)
- Fung CP, "A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis?", Gut, 50, pp.420~424 (2002)
- Cheng DL, "Septic metastatic lesions of pyogenic liver abscess: their association with Klebsiella pneumoniae bacteremia in diabetic patients", Arch Intern Med, 151, pp.1557~1559 (1991)
- Perna AM, "Cardiac tamponade secondary to intrapericardial rupture of a hepatic amoebic abscess", Eur J Cardiothorac Surg, 8, pp.106~107 (1994)
- Jo KH, "Surgical treatment of acute purulent pericarditis", Korean J Thorac Cardiovasc Surg, 17, pp.257~262 (1984)