感染性心内膜炎に合併した化膿性脊椎炎の1例

Pyogenic Spondylitis with Associated Infective Endocarditis : A Case Report

　症例は77歳の女性で，微熱と腰背部痛で内科を受診した．血液培養と心エコー所見から感染性心内膜炎(infective endocarditis：以下IE)と診断された．同時に画像所見から化膿性脊椎炎(pyogenic spondylitis：以下PS)と診断し，抗生剤投与を行ったが，椎体圧潰により両下肢不全麻痺を生じた．臥床安静では改善せず，病巣搔爬＋前方・後方固定術を施行した．術後麻痺は改善し，術後1年後，感染再燃はなく歩行している．PSにIEを合併する頻度は9.3～30.8％と少なくない．発熱・腰背痛でPSを精査する際には，弁膜症の既往などIEのリスクファクターがあり，起因菌がIEの好発菌である際はIEの合併を念頭に心エコーが推奨される．

　We report the case of a 77-year-old woman who presented with pyogenic spondylitis associated with infective endocarditis.　The patient came to our center because of a low-grade fever and back pain.　Infective endocarditis was diagnosed based on the Duke criteria, and pyogenic spondylitis of the thoracic spine was diagnosed based on the radiography findings.　The patient was followed up after treatment with antibiotics, but bilateral leg weakness occurred as a result of collapse of the infected vertebral body.　After remission of the infection, we performed posterior spinal fusion with instrumentation followed by anterior debridement and arthrodesis.　The patient was able to walk unassisted at the 1-year follow-up examination, and bone fusion was complete with no recurrence of the infection.　Infectious endocarditis has been reported in 9.3―30.8% of cases of pyogenic spondylitis, and echocardiography should be performed whenever pyogenic spondylitis is suspected, particularly in patients with risk factors for infective endocarditis and with microorganisms in their blood that cause infectious endocarditis.