重症腎感染症の3例

Abstract

症例1は60歳女で, 糖尿病性ケトアシドーシスの診断にて緊急入院した.左気腫性腎盂腎炎と左腎周囲からの後腹膜・縦隔・胸腔に至る広範囲の炎症像が認められた.左腎摘出術と両側胸腔ドレナージを施行した.縦隔炎・胸膜炎が増悪し, 2ヵ月後に死亡した.症例2は54歳女で, 敗血症ショックの疑いにて緊急入院した.入院から焼く10時間後に死亡し, 血液培養からKlebsiella pneumoniaeが検出された.左腎周囲膿瘍に起因する敗血症性ショックによる死亡と診断された.症例3は56歳女で, 左腎全体および腎周囲の広範な膿瘍形成の認め, 膿瘍からKlebsiella pneumoniaeが検出された.20日後に左腎摘出術を施行し, 術後速やかに解熱した

In renal infections, lack of peculiar symptoms and consequent delay of diagnosis can sometimes lead to a critical condition of the patient. We report three cases of life-threatening renal infections in female patients, two of which were subsequently fata. One patient died of left emphysematous pyelonephritis with bilateral pleuritis. The patient was correctly diagnosed 13 days after the onset of symptoms and expired 2 months later despite nephrectomy on the day of diagnosis. The second patient died of septic shock 3 days following the onset of symptoms. Autopsy revealed multiple perinephric abscess of the left kidney. The non-fatal case was a perinephric abscess spread to the iliopsoas muscle. The patient was diagnosed with perinephric abscess 11 days after the onset of symptoms and eventually underwent nephrectomy 9 days later. Two of the patients were diabetics and the third was a probable diabetic, who died too suddenly to confirm the diagnosis. Herein, we review the literature of, and discuss the diagnosis and management of serious renal infection.