CAPD患者に発症した真菌性精索膿瘍の1例

Abstract

66歳男性.患者は原因不明の慢性腎不全でCAPD導入となり, 右陰嚢腫大より交通性精索水瘤と診断されるも処置は行わなかった.その後, 発熱とCAPD排液の混濁を認め, 細菌性腹膜炎と診断しCEZ, AMKの腹腔内注で軽快したが, その2ヵ月おきに3回の腹膜炎を発症し, CAPD液培養でCandida tropicalisが検出された.真菌性腹膜炎と診断し, FLCZ点滴静注に変更したが難治性であり, CAPDを断念して血液透析に移行した.移行8ヵ月後, 今度は右陰嚢根部腫大で受診となり, 超音波検査で精索に一致して4cmの多房性で内部エコー不均一な腫瘤を認め, CTでは右鼠径部に4cmの軽度壁肥厚を伴う嚢胞構造を認めた.摘出術を施行したところ癒着しており右精索, 精巣とともに摘除し, 同時にヘルニア根治術を行った.病理検査では腫瘤の一部にグロコット染色陽性のカンジダ様真菌の増殖を認めた

A 66-year-old male patient has been on continuous ambulatory peritoneal dialysis (CAPD) since 1993, and was diagnosed with right hydrocele of the spermatic cord in 1998. He repeatedly developed CAPD-related bacterial peritonitis 3 times. In February 2001, hemodialysis was prescribed for treatment of mycotic peritonitis. A palpable mass was noted in the right inguinal region in October 2001 and a computed tomographic (CT) scan disclosed a 4 cm circular lesion with relatively low density and thick wall in the right inguinal region. Spermatic-orchiectomy was performed. Histological diagnosis was mycosis like Candida on the abscess wall. To our knowledge, this is the first case of spermatic cord abscess in a CAPD patient in the Japanese literature.