急性骨髓炎致金黄色葡萄球菌脓毒性肺栓塞一例
【摘要】 脓毒性肺栓塞（SPE）临床上不常见，多数医师对其临床特征认识不足，容易被误诊为肺部真菌病或转移瘤等，甚至行抗真菌治疗。该文报道了1例SPE患者的诊治过程。该例为46岁男性，因右大腿肿痛伴发热、咳嗽、咳痰入院，既往有外伤及2型糖尿病史，血糖控制差，胸部CT提示两肺多发结节影，部分结节影边缘见晕征，部分见空洞影，双侧有少量胸腔积液，脓液分泌物培养示金黄色葡萄球菌感染，予万古霉素抗感染治疗及行右股骨骨髓炎扩创术。术后患者继续使用万古霉素仍有发热，加用利福平后体温恢复正常。后期随访患者情况较好，未见复发。该例的诊治提示，如患者出现急性骨髓炎早期症状，同时胸部影像学出现两肺多发斑片状及团块状实变影或胸膜下的楔形病灶，需警惕急性骨髓炎致SPE。早期诊断是急性骨髓炎致SPE治疗成功的关键。
【关键词】 急性骨髓炎;金黄色葡萄球菌;脓毒性肺栓塞
Staphylococcus aureus septic pulmonary embolism induced by acute osteomyelitis： a case report Wu Changming， Huang Shu， Qian Shuyuan， Xiao Xiong， Liu Jiannan. Department of Respiratory Medicine， Zheng-xing Hospital of Zhangzhou， Zhangzhou 363000， China
Corresponding author， Wu Changming， E-mail： wcmzxyy@ 163. com
【Abstract】 Septic pulmonary embolism （SPE） is not common in clinical practice. Most doctors have poor understanding of the clinical characteristics of this disease. SPE is likely to be misdiagnosed as pulmonary fungal diseases or metastatic tumors， or even treated with antifungal therapy. In this article， the diagnosis and treatment of one case of SEP were reported. The 46 years old male patient was admitted to our hospital due to the swelling pain in the right thing accompanied by fever， cough and expectoration. He had a medical history of trauma and type 2 diabetes mellitus with poor glucose control. Chest CT scan showed multiple sarcoidosis in bilateral lungs. The halo sign was seen at the margin of partial sarcoidosis， and cavit...
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