右膿胸及び右横隔膜下膿瘍の経過中に左大腿静脈カテーテルが原因と考えられた左腸腰筋膿瘍を合併した2型糖尿病の1例

Abstract

A 78-year-old man was receiving regular treatment for diabetes and dementia at our hospital. Diabetes was diagnosed about 10 years previously, at which time the patient's HbA(1)c level had been maintained at 6% by diet therapy and an oral hypoglycemic agent. In July, 2008, he was admitted with fever and hospitalized for pneumonia, which improved with antibiotic treatment and chest drainage. However, pyothorax developed, and in October, 2008 he was admitted again with fever and inflammation. A chest computed tomography (CT) scan revealed a right subphrenic abscess, which improved with antibiotic treatment. He was readmitted for fever and lumbago in November, 2008, and an abdominal CT scan showed a left iliopsoas abscess that did not improve with antibiotic treatment, and had increased in size. Due to infection from the central vein catheter in the left femoral vein inserted at the end of October, the catheter was withdrawn at the end of November. There was a rapid reduction of the left iliopsoas abscess, his inflammation and lumbago symptoms reduced, and he was discharged in January 2009. In cases of dementia in elderly with diabetes, a catheter from a femoral vein is frequently used to prevent complications. However, this method has been known to result in infection at the site of the catheter, and to cause fever. The circumstances of this case strongly support the removal of such a catheter in elderly patients at the first indication of persistent infection.