化膿性脊椎炎に合併した感染性大動脈瘤の1例

Pyogenic Vertebral Osteomyelitis of the Lumbosacral Spine Associated with an Infected Aortic Aneurysm. Case Report

　われわれはメシチリン耐性黄色ブドウ球菌（MRSA）感染性の化膿性脊椎炎に感染性大動脈瘤を合併した1例を経験したので報告する．症例は58歳の男性で，主訴は腰下肢痛と発熱であった．入院時にはCRP 49.5mg/dl，白血球16,700μl と高値を示した．MRIにてL5/S1化膿性脊椎炎を認め，L3/4高位に径30mmの感染性大動脈瘤を合併していた．針生検術でMRSAを検出しバンコマイシンの点滴をするが効果なく，腰仙椎前方固定術施行後リネゾリドの点滴により炎症反応は陰性化した．今回われわれが経験したのは化膿性脊椎炎からの直接もしくは間接波及による感染性大動脈瘤と考えられ，化膿性脊椎炎の郭清と椎体間固定術が有効であった．

　A 53-year-old man came to the emergency department of our hospital because of a high-grade fever, severe low back pain, and lapsing consciousness. He had previously undergone frequent operations for degenerative disc disease in the lumbar spine and been treated with insulin for diabetes mellitus. The radiological diagnosis was pyogenic vertebral osteomyelitis of the lumbosacral spine and psoas abcess. An aortic aneurysm was also observed at the L3 level. Since conservative treatment with vancomycin hydrochloride was ineffective, we performed curettage of the disc and abcess through the peritoneum, and ALIF with an autogeneous iliac bone graft. Postoperatively, we treated the vertebral osteomyelitis with Linezolid. The inflammation decreased, and the CRP value became negative. Because he was a high-risk patient, the infected aortic aneurysm was treated conservatively. The patient became a symptomatic, and there was no deterioration of the infected aneurysm. The patients should be followed carefully for deterioration of the aneurysm and recurrence of the vertebral osteomyelitis.