[논문]카르복시테라피 후 발생한 급성 신우신염 및 근육염 : 증례 보고

선경훈; 허준호; 황용

doi:10.5762/kais.2018.19.8.417

카르복시테라피 후 발생한 급성 신우신염 및 근육염 : 증례 보고
Acute pyelonephritis and myositis after carboxytherapy : A case report 원문보기

한국산학기술학회논문지 = Journal of the Korea Academia-Industrial cooperation Society, v.19 no.8, 2018년, pp.417 - 421

선경훈 (조선대학교의과대학 응급의학과교실) , 허준호 (원광대학교의과대학 응급의학과교실) , 황용 (원광대학교의과대학 응급의학과교실)

초록
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카르복시테라피(Carboxytherapy)는 메조테라피(mesotherapy)와 방법, 치료 조건 및 결과 면에서 매우 유사하다. 그러나 중요한 차이점은 카르복시테라피는 이산화탄소 가스를 피부 바로 아래의 피하층으로 주입하는 반면 메조테라피는 비타민, 미네랄, 그리고 약물의 혼합물을 주입한다는 것이다. 메조테라피의 합병증으로 혈종, 파누스육아종, 봉와직염, 농양 등 이전에 많은 사례들이 보고되었으나, 카르복시테라피는 피하 및 얕은층에 이산화탄소를 주입하고, 이산화탄소는 주입 1주일 안에 흡수되기 때문에 부작용이 거의 보고 되지 않았다. 3일전과 2주전에 한의원에서 카르복시테라피를 받은 29세 여자 환자가 고열, 근육통, 심한 요통 및 엉덩이 부위부터 아래쪽 흉벽까지 피하 기종을 주소로 응급실에 내원하였다. 진단 및 치료를 위해 컴퓨터 단층 촬영을 시행하였으며, 즉시 영상의학과에 판단을 의뢰하였다. 바늘에 의한 손상으로 인한 급성 복막염을 배제할 수 없어 즉각적인 광범위항생제를 투여하였으며, 판독 결과 근육염과 바늘 손상으로 인한 신우신염이 확진되었다. 신우 신염의 경우 적절한 치료가 이루어지지 않으면 패혈증까지 진행할 수 있어 치명적인 결과를 초래 할 수 있다. 따라서 만일 바늘에 찔리거나 침을 맞은 후에 환자가 늑골척추부위나 허리에 통증이 있는 경우 응급의학과 의사는 진단 및 치료를 위해 신속한 초기 평가가 필요하다.

Abstract ▼ AI-Helper

Carboxytherapy is very similar to mesotherapy in terms of methods, conditions it treats, and outcomes. An important difference consider, however, is that carboxytherapy administers carbon dioxide gas into the subcutaneous layer, just underneath the skin, whereas mesotherapy administers a cocktail of vitamins, minerals, and drugs and into the mesoderm of the skin. There have been many previous case reports of complications of mesotherapy such as hematoma, granulomatous panniculitis, cellulitis, and abscesses. However, complications of carboxytherapy have rarely been reported because the carbon dioxide gas is absorbed within a week and is infused into the subcutaneous and superficial layers. A 27-year-old woman who had twice undergone carboxytherapy to reduce abdominal fat (3 days and 2 weeks ago) at an oriental medical clinic visited the emergency department due to high fever, myalgia, severe back pain, and subcutaneous emphysema from the buttocks to the lower chest wall area. A computed tomography (CT) scan was performed for diagnosis and treatment. We immediately started broad spectrum antibiotics and consulted with the department of radiology, which could not rule out acute peritonitis due to needle injury. A radiologist confirmed abdominal myositis and needle puncture induced acute pyelonephritis. Pyelonephritis can even lead to septicemia, which can have fatal consequences. Therefore, if the patient has costovertebral or back pain after undergoing needle puncture or acupuncture therapy, the emergency physcians need careful initial evaluation for diagnosis and treatment.

주제어

AI 본문요약
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문제 정의

There are many reports of mesotherapy complications, but rarely of complications due to carboxytherapy[4-7]. This report discusses the rare occurrence of myositis and acute pyelonephritis after carboxytherapy.

제안 방법

She noted mild chest discomfort and flank pain in both sides following the first treatment and took an analgesic from a local pharmacy for a week for the pain relief. Despite the fact that symptoms were not improved, she underwent a second carboxytherapy procedure. She experienced fever, general ache, and severe flank pain the day after therapy and came to the emergency department as a result.
She had twice undergone carboxytherapy as a cosmetic procedure to reduce abdominal fat (3 days and 2 weeks ago) at an oriental medical clinic. She noted mild chest discomfort and flank pain in both sides following the first treatment and took an analgesic from a local pharmacy for a week for the pain relief. Despite the fact that symptoms were not improved, she underwent a second carboxytherapy procedure.

대상 데이터

Carboxytherapy is very similar to mesotherapy in terms of the methods of the procedure and the conditions it treats. A 27-year-old woman visited to emergency department(ED) in our hospital with fever, headache, vomiting and back pain. Previously, she had undergone carboxytherapy as a cosmetic procedure to reduce abdominal fat at an oriental medical clinic.
A 27-year-old woman was brought by her husband to the emergency department (ED) in our hospital with fever, headache, vomiting and back pain. She had twice undergone carboxytherapy as a cosmetic procedure to reduce abdominal fat (3 days and 2 weeks ago) at an oriental medical clinic.

성능/효과

We could manage APN and myositis successfully using by third generation cephalosporin(ceftriaxone). In conclusion, Pyelonephritis can even lead to septicemia, which can have fatal consequences. Therefore, rapid evaluation and treatment is required.
We performed blood and urine tests and the Focused Assessment with Sonography in Trauma (FAST) to determine the cause of pain and subcutaneous emphysema. The laboratory test results showed a hemoglobin value of 10.9 g/dL, white blood cell count and absolute neutrophil count were elevated to 12,340/mm³ and 11,131/mm³(90.2%), respectively, and serum C reactive protein(CRP) and procalcitonin (PCT), both markers of infection, were elevated to 9.11 mg/dl and 4.27 ng/ml, respectively. Her urinalysis was that WBC many/HPF and RBC 50/HPF (HPF : high power field [x 400]) (Table 2).
Blood culture and urine culture were performed and we started antibiotics (ceftriaxone) due to the possibility of surgery. The tests result was that blood culture was negative and staphylococcus epidermidis was grown in urine culture. Furthermore, we consulted the radiology department to determine the presence of a puncture wound in the peritoneal wall and kidney injury by needle.

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