초록
패혈성 폐 혈전색전증은 드문 질환으로 약물 중독자들에 흔하였으나 점차 감소하는 추세이며 중심 정맥 카테터의 사용, 인공 혈관 장치, 면역억제자와 관련성이 나타나고 있다. 저자들은 기저질환이 없는 건강한 젊은 환자에서 그라목손 음독으로 인하여 스테로이드와 cyclophosphamide 치료 후, 장기간 중심정맥 카테터를 통한 완전 정맥 영양을 시행하는 상태에서 발생한 진균혈증이 심내막염과 내안구염을 동반한 심한 다발성 색전 폐렴과 칸디다 폐동맥 혈전증을 유발하여 항진균제 치료 후 호전된 1예를 경험하여 문헌고찰과 함께 보고하는 바이다.
Septic pulmonary thromboembolism resulting from fungal infection is rare. A 32-year-old woman with acute paraquat intoxication was treated with high-dose intravenous steroid and cyclophosphamide pulse therapy. She presented with a prolonged fever, dyspnea, and multiple pneumonic infiltrations. Central venous catheterization was necessary for total parenteral nutrition. The response to antibiotic therapy was disappointing and Candida tropicalis was cultured in the blood repeatedly. Vegetations were found in the superior vena cava on echocardiography and both pulmonary arteries had massive thromboembolism on computed tomography (CT). Intravenous amphotericin B and anticoagulation therapy showed improvement. When patients with central venous catheters and recurrent fungemia present with dyspnea and fever, septic pulmonary thromboembolism and other disseminated infections, such as infective endocarditis or endophthalmitis, should be kept in mind.