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【緒言】丹毒は，発熱とともに皮膚に出現する浮腫性紅斑を主症状とする真皮の化膿性炎症性疾患であるが，歯性感染症が原因と考えられる顔面丹毒の報告は少ない． 今回われわれは，右側上顎前歯の根尖性歯周炎が原因と疑われた顔面丹毒の1例を経験したので報告する．【症例】患者は67歳の女性. 右側顔面の腫脹を主訴に当科を紹介され受診した．初診時所見として, 右側眼窩下部から右側頬部, 右側顎下部にかけて境界明瞭な紅斑と腫脹を認め，右側上顎3番に根尖性歯周炎を認めた．当初, 右側上顎3番の根尖性歯周炎に起因する頬部蜂窩織炎と診断し, 切開排膿術を施行したが, 排膿を認めなかったことから, 鑑別疾患として丹毒を疑い, 皮膚科対診を行ったところ, 顔面丹毒との臨床診断を得た. 抗菌薬投与後も右側頬部の腫脹および右側上顎3番部の違和感が消失しなかったため, 右側上顎3番の根管開放を行ったところ, 消炎を認め, 第11病日に右側顔面の紅斑は消失した. 約2ヵ月経過した現在, 再発なく経過は良好である．Erysipelas is a pyogenic inflammatory disease of the dermis characterized by erythema with edema appearing on the skin with fever. However, there have been few reports of facial erysipelas caused by dental infection. In this report, we describe a case of erysipelas of the face that was suspected to have been caused by periodontitis of the right maxillary canine tooth.The patient was a 67-year-old woman. She was referred to our department because of right-sided facial swelling. At the time of initial examination, erythema and swelling with well-defined borders were observed from the lower right orbit to the right cheek and lower right side of the jaw. We initially diagnosed her disease as buccal cellulitis caused by periodontitis of the right maxillary canine tooth and therefore performed incisional drainage. However, because there was no drainage of pus, we suspected erysipelas as a differential diagnosis. After consultation with a dermatologist, the patient was diagnosed with facial erysipelas. The swelling in the right cheek area and discomfort in the right maxillary canine tooth persisted after administration of antibacterial drugs; therefore, we created a root canal opening in the right maxillary canine tooth. Eleven days after symptom onset, the erythema on the right side of the face disappeared. After about 2 months, the patient was doing well without any recurrence

顎放線菌症の治療中にDICおよび上部消化管出血を併発した一例

顎放線菌症の治療中に播種性血管内凝固症候群(Disseminated Intravascular Coagulation：DIC)および上部消化管出血を併発した症例を報告する. 患者は89歳女性. 2021年10月中旬に左側下顎8部歯肉の排膿および左側頬部腫脹のため当科を紹介受診した. 初診時, 著しい開口障害と左側頬部腫脹および疼痛を認め, 左側下顎8番智歯周囲炎および左側頬部蜂窩織炎と診断した. その後, 切開排膿時に採取した膿の細菌検査にてActinomyces meyeriおよびその菌塊が検出されたため, 顎放線菌症と最終診断した. 処置および経過：初診日に入院し, 入院3日目の血液検査にて血小板数の低値およびFDP, アンチトロンビン, TATの高値を認め, 日本血栓止血学会の定める診断基準より感染症型DICと診断した. 入院4日目に口腔外切開排膿術およびメロペネム投与を開始し，入院11日目に感染症型DICからの離脱を認めた. また入院9日目より顎放線菌症に対しスルバシリン3.0 g /日を15日間静脈内投与し左側頬部腫脹の軽減を認めていたが, 入院18日目に吐血と著しい貧血を認め内視鏡検査にて上部消化管出血と診断しクリッピングおよび焼灼止血を行い止血した. その後全身状態および開口障害と左側頬部腫脹の改善を認めたため入院43日目に軽快退院となった.Actinomycosis of the jaw, which is slightly rare disease at the oral and maxillofacial region, progress to the disseminated intravascular coagulation irregularly. Here, we report a rare case of the actinomycosis of the jaw complicated with disseminated intravascular coagulation (DIC) accompanied by intestinal hemorrhage. The patient was an 89-years-old woman who had the swelling of the left buccal region and lower-left mandibular gingiva. Above the findings of imaging and bacteriological examination, diagnosis of the actinomycosis of the jaw was made. During antibacterial treatment, her general condition deteriorated rapidly, and the blood test results met the diagnostic criteria of DIC. Moreover, the hematemesis and significant anemia developed during the intensive care, and endoscopy findings showed the hemorrhage at the greater curvature of stomach. Watchful general care should be needed during treatment actinomycosis of the jaw, in particular, affect the elderly

歯性感染症が原因と疑われた顔面丹毒の一例

【緒言】丹毒は，発熱とともに皮膚に出現する浮腫性紅斑を主症状とする真皮の化膿性炎症性疾患であるが，歯性感染症が原因と考えられる顔面丹毒の報告は少ない． 今回われわれは，右側上顎前歯の根尖性歯周炎が原因と疑われた顔面丹毒の1例を経験したので報告する．【症例】患者は67歳の女性. 右側顔面の腫脹を主訴に当科を紹介され受診した．初診時所見として, 右側眼窩下部から右側頬部, 右側顎下部にかけて境界明瞭な紅斑と腫脹を認め，右側上顎3番に根尖性歯周炎を認めた．当初, 右側上顎3番の根尖性歯周炎に起因する頬部蜂窩織炎と診断し, 切開排膿術を施行したが, 排膿を認めなかったことから, 鑑別疾患として丹毒を疑い, 皮膚科対診を行ったところ, 顔面丹毒との臨床診断を得た. 抗菌薬投与後も右側頬部の腫脹および右側上顎3番部の違和感が消失しなかったため, 右側上顎3番の根管開放を行ったところ, 消炎を認め, 第11病日に右側顔面の紅斑は消失した. 約2ヵ月経過した現在, 再発なく経過は良好である．Erysipelas is a pyogenic inflammatory disease of the dermis characterized by erythema with edema appearing on the skin with fever. However, there have been few reports of facial erysipelas caused by dental infection. In this report, we describe a case of erysipelas of the face that was suspected to have been caused by periodontitis of the right maxillary canine tooth.The patient was a 67-year-old woman. She was referred to our department because of right-sided facial swelling. At the time of initial examination, erythema and swelling with well-defined borders were observed from the lower right orbit to the right cheek and lower right side of the jaw. We initially diagnosed her disease as buccal cellulitis caused by periodontitis of the right maxillary canine tooth and therefore performed incisional drainage. However, because there was no drainage of pus, we suspected erysipelas as a differential diagnosis. After consultation with a dermatologist, the patient was diagnosed with facial erysipelas. The swelling in the right cheek area and discomfort in the right maxillary canine tooth persisted after administration of antibacterial drugs; therefore, we created a root canal opening in the right maxillary canine tooth. Eleven days after symptom onset, the erythema on the right side of the face disappeared. After about 2 months, the patient was doing well without any recurrence