悪性リンパ腫症例に発生したフルニエ壊疽の1例

Abstract

症例は83歳の男性で, 高熱と陰嚢の有痛性腫張を主訴に鼠径部の腫瘍生検を行い, 悪性リンパ腫の診断であった.その後, 生検部よりリンパ液の流出と, 39度の高熱が続き生検1ヵ月後に入院となった.陰嚢部の皮下組織に肥厚が認められ, 筋膜炎の存在が疑われた.抗菌剤IPM, CSの投与を開始したところ直ちに解熱したが, 入院10日目より陰嚢皮膚の壊死が見られた.本症例はリンパ節生検部からの感染という経路をとり細菌が侵入, 悪性リンパ腫という免疫能低下の状態で壊疽を生じたものと考えられた

We report a case of Fournier's gangrene. An 83-year-old man underwent biopsy of left inguinal tumor as an outpatient. Pathological diagnosis was malignant lymphoma (diffuse large cell type). Three weeks later, he developed reddened scrotal swelling accompanied with high fever (> 39 degrees C). On admission, antibiotic chemotherapy was initiated. Although his general condition was improved, scrotal necrosis had developed. A computed tomography scan demonstrated thickened subcutaneous tissue over the left lumbar region. Excision of necrotic tissue and sequential irrigation using povidone iodine liquid were effective. The patient then underwent chemotherapy for malignant lymphoma at the internal department. Nine months after the operation, the scrotal skin had completely recovered.