大転子部に発生したサルモネラ菌による骨髄炎の1例

Salmonella Osteomyelitis in a Greater Trochanter : Case Report

　抄録：大転子部に発生したサルモネラ菌による骨髄炎の稀な1例を経験した．症例は36歳，男性であり，誘因なく左股関節から大腿部にかけての疼痛，39℃台の発熱が出現した．近医内科で抗生剤の点滴投与を受けたが軽快せず，2週間後当院に紹介となった．初診時，左股関節から大腿部にかけて強い圧痛を認め歩行困難であった．体温は38.5℃．消化器，呼吸器症状は認めなかった．臨床検査上，白血球13,000，C反応性蛋白4.2と感染徴候を認めた．MRI，CTより左大腿骨骨髄炎，大腿外側広筋内膿瘍と診断した．入院当日より抗生剤の点滴投与を行い約3日で発熱は治まったが，疼痛が残存しており，手術を施行した．骨孔を開窓し，内部を十分に掻爬した．組織よりSalmonella tennesseeが検出された．術後2カ月の現在，感染徴候は認めず疼痛も消失した．

　We encountered a rare case of osteomyelitis in a greater trochanter that was caused by Samlonella. A 36-year-old man was referred to our hospital because of a high fever and pain in the left thigh that made walking difficult. There were no pulmonary or gastrointestinal symptoms, and there was no past history of disease. A diagnosis of osteomyelitis of the greater trochanter was made based on the MRI, CT, and laboratory data. We performed irrigation and curettage, and Salmonella tennessee was isolated from the pus in the abscess. Two months after surgery the patient is symptom-free and has no signs of infection.