A case report of septic metastatic meningitis from Klebsiella pneumoniae liver abscess after hepaticojejunostomy for bile duct cancer

症例は63歳の女性で, 2004年8月胆管癌に対して胆管切除, 胆管空腸吻合術が施行された. 同年11月に発熱がつづいたため入院となった. 入院時の腹部CTにて肝S7を中心に直径8cm大の低吸収域を認め, 胆道再建後の胆管炎に起因する肝膿瘍と診断し, 経皮経肝的ドレナージおよび抗生剤による治療を開始した. 血液および膿汁の培養からKlebsiella pneumoniae が検出された. 入院2日目ごろより頭痛, 意識障害, 項部硬直などの症状が出現し, 髄液の細胞数が増加しており, 細菌性髄膜炎と診断された. 髄液の培養でもK. pneumoniae が検出され, 肝膿瘍からの感染の転移による細菌性髄膜炎と考えられた. 肝膿瘍ドレナージおよび約8週間の抗生剤投与, さらには続発性の水頭症に対する脳室腹腔シャント術により軽快した. 胆管癌術後に発生した細菌性肝膿瘍から遠隔臓器に感染が波及した1典型例として報告する.

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