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Disseminated Septic Lesions Caused by Staphylococcus epidermidis Mimicking Cysticercosis Detected on Ultrasonography in a Pediatric Patient with Acute Myeloid Leukemia

급성 골수성 백혈병 소아환자에서 초음파 검사에서 낭미충증으로 오인된 표피 포도알균에 의한 파종 감염 병변이 발생한 증례

  • Lee, Jae Min (Department of Pediatrics, Cheju Halla General Hospital) ;
  • Choi, Joon-Sik (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Keon Hee (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Yae-Jean (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sun-Ja (Department of Pediatrics, Cheju Halla General Hospital)
  • 이재민 (제주한라병원 소아청소년과) ;
  • 최준식 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 유건희 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김예진 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김선자 (제주한라병원 소아청소년과)
  • Received : 2019.10.04
  • Accepted : 2019.12.05
  • Published : 2020.08.25

Abstract

Staphylococcus epidermidis is a part of the normal skin flora of humans. However, it can cause serious infections in people exposed to foreign bodies or in immunocompromised patients. A 13-year-old boy was hospitalized with fever and myalgia. Painful nodular lesions were detected on the scalp, arms, and legs. Pancytopenia and blasts were present in the peripheral blood. He was diagnosed with acute myeloid leukemia. Magnetic resonance imaging of the whole body showed multiple peripheral rim-enhancing, cyst-like lesions. Ultrasonography showed echogenic nodules inside the cystic lesions in the intramuscular space of the arms and legs. Therefore, cysticercosis was strongly suggested initially. However, an abscess was confirmed on sono-guided biopsy and S. epidermidis was isolated from a microbial culture of the tissue. We report a case of multiple disseminated lesions caused by S. epidermidis in a leukemia patient, initially mistaken for cysticercosis.

표피 포도알균은 사람 피부에 있는 정상균이나, 체내 이물질을 가진 사람이나 면역 저하자에게는 심각한 감염을 일으킬 수 있다. 13세 남자가 발열, 근육통으로 입원하였고 두피, 팔과 다리에 통증이 있는 결절성 병변이 만져졌다. 혈액검사에서 범혈구 감소증과 모세포 80% 소견을 보였고 급성 골수성 백혈병으로 진단되었다. 전신 자기공명영상 검사에서 가장자리 조영 증강을 보이는 다발 낭성 병변이, 초음파 검사에서 에코성 낭성 병변과 그 내부의 에코성 결절이 팔과 다리의 근육 내부에서 관찰되어, 낭미충증이 강력히 의심되었다. 그러나 초음파 유도하 조직 검사에서 농양이 확인되었고, 조직 배양검사에서 표피 포도알균이 동정되었다. 저자들은 백혈병 환자에서 낭미충증으로 오인되었던 표피 포도알균에 의한 전신 다발 병변이 발생한 예를 경험하였기에 보고하는 바이다.

Keywords

References

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