간질환자에서 Vibrio cholerae non-O1에 의한 화농근육염
A case of pyomyositis caused by Vibrio cholerae non-O1 in a patient with liver cirrhosis
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초록
V. cholerae non-O1은 위장관염 또는 균혈증을 발생시키고, 매우 드물게 피부 및 연부조직 감염을 일으킨다. 화농근육염은 황색포도알균이 가장 흔한 균으로 알려져 있으나, 만성 간질환자에서는 비브리오균 같은 그람음성균에 의한 화농근육염이 발생할 수 있다. 이에 저자들은 간경변이 있는 환자에서 여름철에 어패류 생식 후 V. cholerae non-O1에 의한 화농근육염이 발생하여 초기에 진단 후 회복된 예를 국내 처음으로 경험하였기에 이를 보고하는 바이다. 간경변증 환자에서 해산물 또는 바닷물에 노출된 후 발생한 피부 및 연부조직 감염의 경우 V. vulnificus뿐만 아니라 V. cholerae에 의한 감염도 고려해야 한다. 또한 임상적으로 비브리오 패혈증에서 자주 보이는 피부병변이 없다 하더라도 화농근육염이 합병증으로 발생할 수 있으므로, V. cholerae non-O1 균혈증에 사지의 부종, 통증이 동반된 경우 MRI 등을 통한 적극적인 진단을 해야 한다.
Abstract
Vibrio cholerae non-O1 mainly causes gastroenteritis and rarely causes extraintestinal infections, such as bacteremia. Skin and soft tissue infections are also possible, but the incidence rate is very low. Although the most common cause of pyomyositis is Staphylococcus aureus, Gram-negative organisms such as Vibrio species may also cause pyomyositis in patients with chronic liver disease. Pyomyositis caused by Vibrio cholerae non-O1 has not been reported in Korea. Here, we report a case of pyomyositis caused by V. cholerae non-O1 bacteremia in a patient with liver cirrhosis following seafood exposure. This case study suggests that V. cholerae, as well as V. vulnificus, should be considered when soft tissue infections occur in patients with liver cirrhosis after seafood exposure. In addition, physicians should consider imaging studies for a prompt diagnosis if the patient complains of severe pain disproportionate to the skin manifestation.
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