PDF(Pubmed)
Abstract：
Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) can induce life-threatening complications, including acute kidney injury, encephalopathy, and gastrointestinal complications. On the other hand, there have been few reports of cholecystitis associated with STEC-HUS. In this study, we report the case of an 83-year-old Japanese man who developed recurrent acute cholecystitis associated with STEC-HUS. Prior to establishing a definite diagnosis of STEC-HUS, plasma exchange and hemodialysis were initiated, which resulted in a rapid increase in the platelet count and decrease in lactate dehydrogenase levels. The patient presented an enlarged gallbladder detected by computed tomography during the course of treatment. Due to recurrent flare-ups, the patient had to undergo several rounds of endoscopic retrograde biliary drainage and, ultimately, cholecystectomy to prevent relapse of acute cholecystitis. Since cholecystitis was thought to have been caused by complex mechanisms in this case, we discussed those from multiple perspectives. This case report highlights the need for particular care to be given to the management of pre-existing diseases as well as STEC-HUS, especially in older patients.
摘要：
产志贺毒素的大肠杆菌相关溶血性尿毒综合征（STEC-HUS）可诱发危及生命的并发症，包括急性肾损伤,脑病,和胃肠道并发症。另一方面,很少有与STEC-HUS相关的胆囊炎的报道.在这项研究中,我们报道了一例83岁的日本男性患者,他出现了与STEC-HUS相关的复发性急性胆囊炎.在明确诊断STEC-HUS之前，开始血浆交换和血液透析，导致血小板计数迅速增加，乳酸脱氢酶水平下降。患者在治疗过程中通过计算机断层扫描检测到胆囊增大。由于反复发作，患者不得不接受几轮内镜下逆行胆道引流，最终,胆囊切除术预防急性胆囊炎复发。由于胆囊炎被认为是由复杂的机制引起的，我们从多个角度进行了讨论。本病例报告强调了对已有疾病以及STEC-HUS的管理给予特别护理的必要性。尤其是老年患者。
