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증례 : 감염 ; Aerococcus viridans에 의한 요로성패혈증 1예
정진성 ( Jin Sung Jung ),장세헌 ( Se Heon Chang ),유승현 ( Seung Hyen Yoo ),구남호 ( Nam Ho Koo ),박용원 ( Yong Won Park ),천미주 ( Mi Ju Cheon ),채윤태 ( Yun Tae Chae ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2
요양 시설에서 지내던 79세 여성이 요로성 패혈증으로 입원하였으며 소변 및 혈액 배양 검사에서 모두 Aerococcus viridans 가 동정되었다. 항생제 감수성 결과에 따라 ciprofloxacin을 정맥으로 총 2주 투여하였고 환자는 추가적인 합병증이 발생하지 않고 완치되었다. 이에 저자들은 드물게 보고되는 A.viridans에 의한 요로감염 사례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 비록 A. viridans가 사람에게 드문 감염균이지만 이번 사례처럼 요로성 패혈증 같은 심각한 감염증의 원인이 될 수도 있으므로 혈액 또는 소변 배양 검사에서 균이 동정될 경우 항생제 감수성 결과에 따라 적절한 항생제 치료가 신속히 행해져야 할 것이다. Aerococcus viridans is a rare pathogen in humans, with only six cases of A. viridans urinary tract infections reported worldwide. Nosocomial urinary tract infections with bacteremia caused by A. viridians are even rarer, with no prior reports of urosepsis caused by A. viridans occurring in the Republic of Korea. Here we report a case of urosepsis caused by A. viridans in a 79 year-old female nursing home resident. The patient was admitted to the hospital presenting a fever of 39℃, chills, and oliguria for two days prior to admission. Urine culture yielded a robust growth of 105 CFU/mL of A. viridians, with blood culture positive for the same organism. Following diagnosis, the patient was treated with ciprofloxacin intravenously for 2 weeks, resulting in clearance of the infection and a full recovery from urosepsis. Although A. viridans is rarely associated with human infections, this case shows that, under the right conditions, it can be responsible for severe infections like urosepsis. (Korean J Med 2014;87:234-239)
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임대섭 ( Dae Seop Lim ),정은수 ( Eun Soo Jeong ),정진성 ( Jin Sung Jung ),장세헌 ( Se Heon Chang ),유승현 ( Seung Hyen Yoo ),장우진 ( Woo Jin Jang ),정시정 ( Shi Jung Chung ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.6
Paradoxical embolism is a kind of stroke caused by embolism of thrombus of venous origin through a lateral opening in the heart, such as a patent foramen ovale (PFO). Although the most frequent manifestation of paradoxical embolism is cryptogenic stroke, noncerebral paradoxical embolism is also associated with PFO. We experienced a case of cryptogenic renal infarction in a previously healthy 70-year-old man. He had no cardiac thrombus on transthoracic echocardiography and electrocardiogram revealed a normal sinus rhythm. Because it was cryptogenic renal infarction, we performed transesophageal echocardiography with microbubble test. Microbubble test using agitated saline proved the presence of right-to-left shunt and patent foramen ovale was diagnosed. We also performed lower leg doppler ultrasonogram, but there was no evidence of deep vein thrombosis. Although only the presence of a right-to-left shunt is not enough to establish the diagnosis of paradoxical embolism, it is uncommon for the source of the embolism to be identified. In this case, we concluded that paradoxical embolism is the cause of renal embolism. We report paradoxical renal embolism through PFO with review of relevant literatures.
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