保存的に治癒しえたMRSA腰部硬膜外膿瘍の1例

Conservatively Treated Lumbar Epidural Abscess Caused by Methicillin-resistant Staphylococcus Aureus ; Case Report

　抄録：保存的に治癒しえたMRSA腰部硬膜外膿瘍の1症例を経験したので報告する．症例は44歳の女性で腰痛と左下肢痛を主訴に来院した．MRI上，L5/S1レベルで左後下方に突出したヘルニア像を認めた．疼痛が強く硬膜外チューブによる持続注入を施行したところ，4日後に発熱，頭痛を生じた．発症後3日のMRIでL3上縁よりL5下縁レベルの前方硬膜外腔に膿瘍像を認め，カテーテル先端の培養よりMRSAが検出された．抗生剤の投与を開始し，3週後には症状および炎症所見の改善がみられ，6週後のMRIにて膿瘍像は消失した．発症後2年10カ月の現在，再発の所見は認められず，ヘルニアによる腰，下肢痛も消失している．過去の報告では，腰部硬膜外膿瘍に対し神経症状がなくとも予防的に手術療法を選択している症例が多くみられるが，われわれは神経症状がなくMRIにて早期診断され，起因菌が同定されればMRSAによる腰部硬膜外膿瘍においても保存療法の適応と考えた．

　We report a case of conservatively treated lumbar epidural abscess caused by methicillin-resistant staphylococcus aureus (MRSA).

　A 44-year-old woman presented with low back pain and left leg pain. The magnetic resonance imaging (MRI) demonstrated L5-S1 lumbar disc herniation. Four days after epidural catheterization, she developed high fever and complained headache. The MRI revealed L3-L5 epidural abscess, and MRSA was detected from tip of the catheter. With intravenous administration of MINO and TEIC for 3 weeks, her headache and inflammatory signs were improved. The abscess disappeared on the MRI taken 6 weeks after the onset. She has had ever no recurrence for 34months.

　Many reports recommended immediate surgical débridement for lumbar epidural abscess even in case of no neurologic symptoms. However, the patients with lumbar epidural abscess without neurological deficits can be treated conservatively, if the correct diagnosis including detection of the responsible bacteria at early phase, even in case of MRSA infection.