ヨードホルム中毒を生じた頚部ガス壊そ症例

Abstract

A case of iodoform toxicity is presented in a patient after the treatment of neck gas gangrene. Although iodoform has been widely used for the treatment of wounds, there are few case reports about its side effects, such as headache, consciousness disturbance, delirium and tachycardia. We describe a 56-year-old blind male who under-went hemodialysis for chronic renal failure, with neck gas gangrene. Nonclostridial gas gangrene of the deep neck was improved by surgical drainage and wide debridment of necrotic tissue in combination with conservative treatment. Four kinds of anaerobic gram-positive bacteria including Peptostreptococcus micros were detected in pus. After surgical treatment, we used iodoformgauze (0.22g/day) in the open wounds of the neck. Two days after the iodoform application, he became confused, then delirius. Total serum iodine concentration was high (7440μg/dl; normal range, 4.0 to 9.0μg/dl). To our knowledge, this value of iodine concentration is the highest of the previous patients reported as having iodoform poisoning. We stopped iodoform use and performed direct hemoperfusion, which was considered effective to reduce total serum iodine. The patient became conscious, and was discharged 46 days after hospitalization.