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症例は74歳,女性。発熱,右側腹部痛を主訴に来院し,腎盂腎炎の診断にて入院となった。保存的加療にて改善がみられない腎膿瘍と診断し,右腎摘除術を施行した。術後も発熱,疼痛が続き,腎摘後10日目に下肢の神経症状が出現した。脊椎疾患を疑いMRI検査を施行したところ,腰椎椎間板を中心に炎症所見を認め,化膿性脊椎炎と診断された。比較的稀な疾患であるが,尿路系疾患に併発することが多いとされており,泌尿器科医が十分に認識しておくべき疾患であると思われた。
We report a case of a 74-year-old female patient with pyogenic spondylitis. She was admitted for severe right flank pain and high fever. At first, we selected a conservative therapy consisting of bed rest and antibiotics under the diagnosis of acute pyelonephritis for about one month, followed by right nephrectomy performed for renal abscess. However, for more than a week after the operation, severe back pain and high fever persisted. On the 10th postoperative day, she developed a femoral pain, which helped us diagnose pyogenic spondylitis. Magnetic resonance imaging(MRI) showed an inflammatory region in the L4/5 intervertebral disk. Urologists should be aware of the possibility of pyogenic spondylitis secondary to urinary tract infection.(Rinsho Hinyokika 61:161-164, 2007)
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