小児膝骨関節結核の治療経験

Osteoarticular Tuberculosis of the Knee of a 2-Year-Old Boy. Case Report

　今回，2歳の幼児の膝関節に発生した結核性骨関節炎を経験したので報告する．症例は2歳の男児で，誘因なく歩かなくなったとのことで近医を受診した．初診時に膝関節の軽度腫脹を認め経過観察されていたが，発症後3カ月の関節液PCR検査で結核菌が検出され結核性骨関節炎と診断，抗結核薬の投与と病巣掻爬を行った．術後約6年において，関節炎の再発や可動域制限，内外反変形，脚長差は認めていない．結核性骨関節炎は若年者においては成長障害の可能性も考え，膝関節炎の鑑別診断の1つとして考慮せねばならない．

　The diagnosis of osteoarticular tuberculosis is often overlooked because of the absence of clinical findings.　We report the case of a small child with osteoarticular tuberculosis of the knee.　The patient was a 2-year-old boy whose parents took him to be examined, because he would not walk without any inducements.　Inspection revealed slightly swelling of his left knee, but the blood tests were all negative.　Three months later, tubercle bacilli were detected in a synovial fluid specimen, and MRI showed multiple abcesses around the knee.　A diagnosis of osteoarticular tuberculosis of the knee was made, and the patient was treated surgically and with antitubercular drug therapy.　As of 6 years postoperatively, there has been no recurrence of the osteoarthritis, limited range of motion (ROM), a varus-valgus deformity, and leg-length discrepancy.　Because of the possibility of growth impairment in children with osteoarthritis, it must be included in the differential diagnosis of arthritis of the knee.