胸鎖乳突筋の内部を進行し, 内頸静脈血栓症を合併した壊死性軟部組織感染症の１例

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  • A case of necrotizing soft tissue infection that progressed inside the sternocleidomastoid muscle, complicated by jugular vein thrombosis
  • キョウ サニュウトツキン ノ ナイブ オ シンコウ シ,ナイ ケイ ジョウミャク ケッセンショウ オ ガッペイ シタ エシセイナンブ ソシキ カンセンショウ ノ 1レイ

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Necrotizing soft tissue infection is a serious infection that progresses widely and rapidly, mainly through the skin, subcutaneous tissue and fascia, but rarely inside muscle. We report a case of necrotizing soft tissue infection triggered by odontogenic infection that progressed inside the sternocleidomastoid muscle （SCM） and was complicated by jugular vein thrombosis.<br> 　The patient was a 52-year-old man who showed trismus, dyspnea and severe swelling accompanied by redness in the right buccal region, submandibular region and neck.<br> 　A blood test showed a WBC of 18,000/μL and CRP of 12.30 mg/dL. A contrast-enhanced computed tomography image showed an abscess with gas accumulation inside the SCM and in the submandibular region, and the internal jugular vein was occluded, with thrombus formation suspected. On the same day, under general anesthesia, the abscess pus and gas were released through a submandibular incision, and a drain was inserted along the SCM. The inflammation gradually improved under 15 days of administration of SBT/ABPC（12 g/day） and CLDM（1,200 mg/day）. Postoperative contrast-enhanced CT showed no occlusion of the internal jugular vein and the thrombus had disappeared. The patient was discharged on the 21st hospital day.

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