A Case of Alkaptonuria Presenting with Necrotizing Soft Tissue Infection Caused by <i>Citrobacter koseri </i>that Required Surgical Treatment

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  • <i>Citrobacter koseri </i>による壊死性軟部組織感染症を呈し外科的処置を要したアルカプトン尿症の1 例
  • 症例 Citrobacter koseriによる壊死性軟部組織感染症を呈し外科的処置を要したアルカプトン尿症の1例
  • ショウレイ Citrobacter koseri ニ ヨル エシセイナンブ ソシキ カンセンショウ オ テイシ ゲカテキ ショチ オ ヨウシタ アルカプトン ニョウショウ ノ 1レイ

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<p>A 75-year-old man with a history of alkaptonuria, who had gradually become bedridden due to repeated episodes of arthropathy, presented to his physician with a dayʼs history of fever and right knee joint pain. He was diagnosed by knee puncture as having purulent knee arthritis, and was started on intravenous cefazolin treatment ; however, there was no improvement. Four days after, the patient went into septic shock and was admitted to our hospital. Multidrug-resistant Citrobacter koseri (C. koseri) was detected by various bacterial cultures (blood, urine, and right knee joint fluid), and he was initiated on treatment with the appropriate antibacterial drugs based on the results of sensitivity results ; however, the right knee arthritis became worse. Contrast-enhanced CT revealed necrotic soft tissue infection extending from the distal right thigh to the muscle layer around the knee joint. Surgical intra-articular irrigation and incision were performed to drain the medial thigh abscess, followed by appropriate antibiotic treatment. The patientʼs general condition and surgical wound improved gradually, and he was discharged our hospital one month later. Severe C. koseri infections can occur in patients with alkaptonuria because of their increased susceptibility to infections. Early source control of the infection site is important for the treatment of necrotizing soft tissue infection.</p>

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 94 (6), 834-838, 2020-11-20

    The Japanese Association for Infectious Diseases

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