頰粘膜癌に対する動注化学放射線療法後にカテーテル感染から感染性腹部大動脈瘤を生じた1例

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  • A case of infected abdominal aortic aneurysm caused by catheter infection after intra-arterial chemoradiotherapy for buccal mucosa cancer
  • ホオ ネンマクガン ニ タイスル ドウ チュウ カガク ホウシャセン リョウホウ ゴ ニ カテーテル カンセン カラ カンセンセイ フクブ ダイ ドウミャクリュウ オ ショウジタ 1レイ

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<p>We report on a 68-year-old man in whom a catheter-related bloodstream infection associated with an aortic aneurysm developed after intra-arterial chemoradiotherapy for buccal mucosa cancer. On the 18th day of concurrent intra-arterial chemoradiotherapy, he had a fever (body temperature 40°C) associated with an increased white blood cell (WBC) count. Venous blood was collected, and Meropenem was administered after a blood culture (MRSA negative) was performed. A slight fever continued, and intra-arterial catheter infection was suspected. On the 29th day of concurrent intra-arterial chemoradiotherapy, the superficial temporary artery catheter was removed (MRSA negative) with re-catheterization of the occipital artery. Thereafter, an intra-arterial catheter infection was newly suspected on the 15th day after re-catheterization, and the intra-arterial catheter was removed( MRSA detected). Following intra-arterial catheter removal, inflammatory findings tended to improve. On the 15th day after intra-arterial catheter removal, the patient complained of abdominal distention and pain. The WBC and CRP were elevated, and an infected abdominal aortic aneurysm was diagnosed on computed tomography. Abdominal pain worsened even during treatment with vancomycin, and the patient was transferred to a high-level care facility. Owing to the suspicion of impending rupture of the abdominal aortic aneurysm, emergency abdominal aortic resection of the infected segments and autologous vein graft replacement surgery were performed. He showed satisfactory progress thereafter and was discharged 3 weeks after operation.</p>

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