黄色ブドウ球菌による感染性心内膜炎と肺梗塞,感染性肺動脈瘤を併発した心室中隔欠損症(VSD)を有するDown症の1症例(東京女子医科大学東医療センター小児科開局40周年記念論文集)

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We report a case of infectious endocarditis, pulmonary infarction and infectious pulmonary artery aneurysm caused by methicillin susceptible Staphylococcus aureus (MSSA). The patient was a 24-year-old woman with Down syndrome and VSD, presenting with fever and cough since April 2001. High fever persisted despite antibiotic treatment with ceftazidime, ampicillin, amikacin sulfate and levofloxacin. She was admitted to our hospital on May 22. MSSA was detected on blood culture, and the DIC score was 7. Chest radiography revealed pneumonia and massive pleural effusion, and echocardiography revealed a vegetation on the tricuspid valve. Treatment was started with panipenem/betamipron 2 g/day, vancomycin hydrochloride 2 g/day. Few days later, chest CT revealed obstruction of the right pulmonary artery and pulmonary infarction caused by an infected embolism was diagnosed. Chest MRI revealed dilatation of the right pulmonary artery by a bipartite pulmonary aneurysm of 2 cm diameter. Since blood culture remained positive, treatment was switched from PAPM/BP to CEZ 6 g/day, and rifampicin, clarithromycin were added. The patient responded well and was discharged on September 20. However, on October 25, she died at another hospital of sudden hemoptysis; rupture of the pulmonary artery aneurysm was suspected.
2007-05-31