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A Case of Brain Death Caused by Salmonella Enterica Serovar Enteritidis Bacteremia

뇌사를 초래한 Salmonella Enterica Serovar Enteritidis 균혈증 1예

  • Oh, Dae-Myung (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Kwon, Ki-Tae (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Bae, Soo-Hyun (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Lee, Mi-Jung (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Seol, Soo-Hwan (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Do, Won-Seok (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Jun, Byoung-Kwon (Daegu Institute of Health & Environment)
  • Published : 2012.05.01

Abstract

We present a case report of brain death caused by Salmonella enterica serovar Enteritidis bacteremia. A 53-year-old diabetic male was admitted to our hospital with stupor mentality and fever. No evidence of meningitis was found upon cerebrospinal fluid analysis, but diffuse brain edema was shown by magnetic resonance imaging. S. Enteritidis phage type 7 was isolated from blood cultures. We diagnosed the patient with encephalopathy associated with S. Enteritidis bacteremia and treated him by intravenous administration of ceftriaxone and dexamethasone. Fifteen days after admission, the patient was diagnosed with brain death and became a cadaveric donor. Although encephalopathy associated with S. Enteritidis bacteremia is rare, it should be considered as a serious and potentially lethal complication.

NTS 뇌증은 매우 빠르게 진행하며, 높은 사망률과 심각한 신경학적 후유증을 남긴다. 아직까지 NTS 뇌증에 대한 정확한 병태생리학적 기전에 대한 이해와 치료 방법은 없는 상태이다. 저자들은 Salmonella enterica serovar Enteritidis 균혈증에 동반된 뇌증 환자를 적절한 항생제와 dexamethasone으로 치료하였으나 급격한 신경학적 악화로 뇌사까지 진행되어 장기 기증을 위해 장기 적출술을 시행한 1예를 경험하였다. S. Enteritidis 균혈증 환자를 치료할 때, 드물지만 뇌사를 일으킬 정도로 심각한 신경학적 후유증이 발생할 수 있으므로 주의 깊게 경과를 관찰하여야 한다.

Keywords

References

  1. The Korean Society of Infectious Diseases. Infectious Diseases. 1st ed. Seoul: Koonja publishing, 2007:423-433.
  2. Ryu CB, Lee ML, Namgoong EK, Kee SY, Lee WG, Woo JH. Bacteremia with nontyphi Salmonella and therapeutic implication. Korean J Intern Med 1995;10:146-149. https://doi.org/10.3904/kjim.1995.10.2.146
  3. Arii J, Tanabe Y, Miyake M, et al. Clinical and pathologic characteristics of nontyphoidal salmonella encephalopathy. Neurology 2002;58:1641-1645. https://doi.org/10.1212/WNL.58.11.1641
  4. Martin K, Sharland M, Davies EG. Encephalopathy associated with Salmonella enteritidis infection. Scand J Infect Dis 1994;26:486-488. https://doi.org/10.3109/00365549409008624
  5. Ichikawa K, Kajitani A, Tsutsumi A, Takeshita S. Salmonella encephalopathy successfully treated with high-dose methylpredonisolone therapy. Brain Dev 2009;31:782-784. https://doi.org/10.1016/j.braindev.2008.12.019
  6. Imamura M, Nishi J, Tamada I, Tenokuchi Y, Toyoshima M, Kawano Y. Proinflammatory cytokines in cerebrospinal fluid from patients with nontyphoidal Salmonella encephalopathy. Pediatr Infect Dis J 2008;27:558-559. https://doi.org/10.1097/INF.0b013e318166356c
  7. Nakahata T, Tsugawa K, Waga S, Tanaka H. Acute renal failure with encephalopathy following Salmonella enteritidis infection. Pediatr Nephrol 2006;21:1209-1210. https://doi.org/10.1007/s00467-006-0114-6
  8. Minami K, Yanagawa T, Okuda M, et al. Cerebrospinal fluid cytokines in Salmonella urbana encephalopathy. Tohoku J Exp Med 2004;203:129-132. https://doi.org/10.1620/tjem.203.129
  9. Davies NW, Sharief MK, Howard RS. Infection-associated encephalopathies: their investigation, diagnosis, and treatment. J Neurol 2006;253:833-845. https://doi.org/10.1007/s00415-006-0092-4