耐甲氧西林金黄色葡萄球菌肺炎并发败血症及多处动脉瘤和动脉血栓一例报告并文献复习

目的提高对耐甲氧西林金黄色葡萄球菌（MRSA）肺炎并发败血症及动脉瘤和动脉血栓的认识。方法结合1例MRSA肺炎并发败血症及多处动脉瘤和动脉血栓患者的临床资料进行文献复习，对MRSA败血症的并发症、动脉瘤及动脉血栓的病理生理以及三者之间的内在联系进行分析。结果患者，男，66岁，因“发热、咳嗽、咯痰1个月余”于2006年8月16日入院。入院前发热1个月，入院时体温达40℃，入院后抗感染治疗10d左右体温降至正常，2次血培养及痰培养（痰液经镜检，均为标准痰）均为MRSA，诊断为院外感染的MRSA肺炎、败血症。静脉滴注万古霉素抗感染治疗后体温降至正常，但随后出现发热、疼痛、搏动性包块三联征，经B型超声及双下肢强化CT确诊为双侧髂外动脉、双侧臀上动脉多发性动脉瘤并附壁血栓形成、双侧股动脉及双侧股深动脉血栓形成等并发症。结论MRSA肺炎、败血症合并多发动脉瘤及动脉血栓非常少见，其原因可能是在动脉炎的基础上，内皮细胞损伤，引起了一系列凝血反应；血管肌层受损可导致或加重动脉扩张，形成动脉瘤。

Methacillin resistant staphyloccocus aureus pneumonia complicated with septicemia, multiple aneurysms and arterial thrombosis: a case report and review of the literature

OBJECTIVE: To improve the understanding of the clinical manifestations of complications caused by methacillin resistant staphyloccocus aureus (MRSA) pneumonia. METHODS: A case of MRSA pneumonia complicated by septicemia, multiple aneurysms and arterial thrombosis was reported, and the literature was reviewed. The pathogenesis of MRSA septicemia, aneurysm and arterial thrombosis was discussed. RESULTS: A 66 year old male was admitted to this hospital because of fever, cough and sputum production for 1 month. The temperature on admission was 40 degrees C. Blood cultures for 2 times and sputum cultures all grew MRSA. The diagnosis of community acquired MRSA pneumonia and septicemia was made. The temperature returned normal after intravenous vancomycin therapy. But localized fever, pain and pulsating masses were noted, and ultrasonography and CT scanning revealed aneurysm formation in the external iliac arteries and the bilateral superior gluteal arteries, and arterial thrombi in the bilateral femoral arteries and deep femoral arteries. CONCLUSIONS: MRSA pneumonia complicated with multiple aneurysm and arterial thrombosis is uncommon. Endothelial injury caused by arteritis may lead to blood coagulation, and vascular muscle injury can cause or aggravate arterial dilatation and aneurysm.