化膿性関節炎から敗血症性肺塞栓症を発症した1例

Septic Pulmonary Embolism Occurring from Suppurative Arthritis: A case report

要旨　患者は54歳，男性．2年前に糖尿病を指摘されたが放置していた．右膝関節痛と歩行困難のため当院整形外科に入院し，化膿性関節炎と診断された．入院翌日に血圧低下および低酸素血症を認め，敗血症性ショックと考えられた．胸部CTにて両側肺野に多発する斑状結節影を呈したことから，敗血症性肺塞栓症と診断した．抗菌薬の全身投与および関節鏡下滑膜切除術とセメントビーズ留置術を施行したところ，全身状態は速やかに改善した．敗血症性肺塞栓症の感染原因として関節炎も考慮すべきであり，積極的局所治療がより効果的であると考えられた．

　Septic pulmonary embolism(SPE) due to suppurative arthritis is very rare. A 54-year-old man who had untreated diabetes mellitus was admitted with right gonalgia and dysbasia due to suppurative arthritis. He was in a condition of septic shock presenting with hypotension and hypoxemia. Bilateral multiple cavitary nodules with feeding vessel signs in chest computed tomography led to the diagnosis of a septic pulmonary embolism(SPE) occurring from suppurative arthritis. The patient's general condition improved quickly under treatment by intravenous administration of cefepime dihydrochloride, arthroscopic synovectomy and antibiotic polymetylmethacrylate beads in the right knee cavum articulare. Severe SPE due to suppurative arthritis should be treated with administration of antibiotics and aggressive intervention in the local infectious lesion.