硬膜外膿腫からMSSA菌血症となり食道静脈癌破裂にいたったアルコール性肝硬変の一例

Abstract

Here we present a case of variceal hemorrhage induced by methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with epidural abscess in alcoholic cirrhosis. A 65-year-old man with a prior diagnosis of alcoholic cirrhosis, type 2 diabetes mellitus, and hypertension presented with hematemesis to the community hospital He was referred to our hospital for further examination and treatment because sources of bleeding were not identified, despite the existence of esophageal varices during the endoscopic examination at the community hospital. Laboratory examination revealed hemoglobin of 10g/dl, total leukocyte count of 8000 with 76% of neutrophils, platelet count of 470,000/μ1, and prothrombin time of 64%. An emergency endoscopy in our hospital revealed esophagogastric varices (LmF2CbRC2-Lg-cfF2RC0) without active hemorrhage. EIS was performed with 5% ethanolamine oleate to treat esophageal varices on days 2 and 14 of his hospital stay. Follow-up esophagogastroduodenoscopy after EIS demonstrated improvement of esophageal varices graded as LiCwF1RC0. He was admitted with a temperature of 40.0℃ and a complaint of severe back pain. He was identified as being positive for MSSA, and severe back pain remained unchanged. Magnetic resonance imaging revealed a spinal epidural abscess and pyogenic spondylodiscitis at L3-L4 on day 9 of his hospital stay. He was intravenously administered antibiotics for 5 weeks during admission. His temperature returned to normal, and blood tests for markers, such as white blood count and C-reactive protein level, were completely normalized on the day 16 of his stay. He was discharged on oral antibiotics on the day 36 in good condition.