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Mycobacterium abscessus에 의해 발생한 지속적 외래 복막투석 관련 복막염 1예

A Case of Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis Caused by Mycobacterium abscessus

  • 안혜원 (연세대학교 의과대학 내과학교실) ;
  • 조용인 (연세대학교 의과대학 내과학교실) ;
  • 한상훈 (연세대학교 의과대학 내과학교실) ;
  • 최준용 (연세대학교 의과대학 내과학교실) ;
  • 송영구 (연세대학교 의과대학 내과학교실) ;
  • 최규헌 (연세대학교 의과대학 내과학교실) ;
  • 김준명 (연세대학교 의과대학 내과학교실)
  • Ann, Hea Won (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Cho, Yong In (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Han, Sang Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Jun Yong (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Song, Young Goo (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Kyu Hun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, June Myung (Department of Internal Medicine, Yonsei University College of Medicine)
  • 투고 : 2012.11.19
  • 심사 : 2013.10.11
  • 발행 : 2014.07.01

초록

M. abscessus는 자연환경에 널리 분포되어 있으며 면역 저하 환자에게 심각한 감염증을 일으킬 수 있는 병원균이다. 국내에서는 M. abscessus에 의해 발생한 복막투석 관련 복막염이 보고되어 있지 않지만 세균 배양에서 병원균이 동정되지 않거나 경험적 항생제 치료에 호전되지 않는 복막투석 관련 복막염 환자에서 고려해야 할 감염 원인 균주 중의 하나이다. 저자들은 지속적 외래 복막투석을 시행하는 환자에서 M. abscessus에 의해 발생한 복막염을 경험하여 문헌고찰과 함께 보고하는 바이다.

Mycobacterium abscessus has been reported to cause opportunistic infections in immunocompromised patients. It is a very rare pathogen in continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis. However, we experienced a single case of peritonitis caused by M. abscessus in a patient on CAPD in South Korea. A 52-year-old female on CAPD for 9 years with a past history of recurrent CAPD-associated peritonitis presented with fever, abdominal pain and turbid peritoneal dialysate. CAPD-associated peritonitis did not improve with broad-spectrum antibiotic treatment, and pathogens were not detected in a routine peritoneal fluid bacterial culture. M. abscessus was isolated from a peritoneal fluid mycobacterial culture. The patient recovered after treatment with clarithromycin and levofloxacin for 24 months.

키워드

참고문헌

  1. Choi GE, Jo YS, Shin SJ. Current understanding of mycobacterium abscessus infection. J Bacteriol Virol 2012;42:17-30. https://doi.org/10.4167/jbv.2012.42.1.17
  2. Koh WJ, Kwon OJ, Jeon K, et al. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest 2006;129:341-348. https://doi.org/10.1378/chest.129.2.341
  3. Ko WJ, Kwon OJ, Ham HS, et al. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens. Korean J Med 2003;65:10-21.
  4. Renaud CJ, Subramanian S, Tambyah PA, Lee EJ. The clinical course of rapidly growing nontuberculous mycobacterial peritoneal dialysis infections in Asians: a case series and literature review. Nephrology (Carlton) 2011;16:174-179. https://doi.org/10.1111/j.1440-1797.2010.01370.x
  5. Wood GL, Brown-Elliott BA, Conville PS, et al. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; approved standard-second edition. CLSI 2011;31:M24-A22.
  6. Li PK, Szeto CC, Piraino B, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010;30:393-423. https://doi.org/10.3747/pdi.2010.00049
  7. Song Y, Wu J, Yan H, Chen J. Peritoneal dialysis-associated nontuberculous mycobacterium peritonitis: a systematic review of reported cases. Nephrol Dial Transplant 2012;27:1639-1644. https://doi.org/10.1093/ndt/gfr504
  8. Song JY, Son JB, Lee MK, Gwack J, Lee KS, Park JY. Case series of mycobacterium abscessus infections associated with a trigger point injection and epidural block at a rural clinic. Epidemiol Health 2012;34:e2012001. https://doi.org/10.4178/epih/e2012001
  9. Chung SH, Roh MI, Park MS, Kong YT, Lee HK, Kim EK. Mycobacterium abscessus keratitis after LASIK with IntraLase femtosecond laser. Ophthalmologica 2006;220:277-280. https://doi.org/10.1159/000093084
  10. Kameyama H, Mori Y, Kimura T, et al. A case report of Mycobacterium abscessus peritonitis in a peritoneal dialysis patient. Ther Apher Dial 2007;11:449-451. https://doi.org/10.1111/j.1744-9987.2007.00526.x