腰椎化膿性椎間関節炎の1例

Pyogenic Arthritis of a Lumbar Facet Joint. Case Report

　稀である腰椎化膿性椎間関節炎を経験したので報告する．症例は56歳の女性で，主訴は腰下肢痛および発熱であった．MRIにて左L3/4椎間関節内およびその背側にT2高輝度の所見を認め，炎症反応の上昇がみられた．左L3/4椎間関節部の穿刺，洗浄ドレナージ施行し，培養にて黄色ブドウ球菌が検出された．感受性のある抗菌剤を投与し，保存的加療で臨床症状と炎症反応の改善を認めた．化膿性椎間関節炎は，本邦では自験例を含めて詳細のわかる報告は7例であった．本例では膿瘍の穿刺により起炎菌を同定でき，抗菌剤の投与が有効であった．

　We report a case of pyogenic arthritis of a lumbar facet joint. A 56-year-old woman presented with low back pain, left thigh pain, and a high-grade fever. Laboratory tests on admission showed an increased leukocyte count and serum C-reactive protein (CRP) level. Palpation revealed tenderness over the left paravertebral muscles (PVMs) at the L3-4 level, but there was no swelling, redness, or local heat. Magnetic resonance imaging (MRI) showed abnormal intensity in the left L3/4 facet joint and PVMs. Based on these findings, we made a diagnosis of pyogenic arthritis of a lumbar facet joint. Centesis was performed, and a small amount of yellow pus was removed from the facet joint. Just after that we washed and drained. Staphylococcus aureus was detected in cultures of the pus. Appropriate antibiotics were administerd by intravenous drip infusion. Conservative treatment resulted in improvement of the clinical manifestations, and the signs of infection resolved. MRI one week after the onset of symptons was useful in making the diagnosis.