両側水腎症を来した子宮放線菌症

Actinomycosis of the uterus caused bilateral hydronephrosis : A case report

　79歳女性．嘔吐と発熱を主訴に前医を受診，CTで骨盤内腫瘤に伴う右水腎症を認めたため当科に紹介された．閉塞性腎盂腎炎の診断で右尿管ステント留置と抗菌薬治療を開始し，その後の検査で骨盤内腫瘤は子宮放線菌症と診断された．抗菌薬治療を継続していたが，病変の増大による左水腎症と腸閉塞が出現し，左尿管ステントと胃管の留置を要した．最終的に保存的治療のみで治癒し，侵襲的治療が回避可能であった．

Abstract

A 79-year-old woman presented with vomiting and fever and was referred to our department. Right hydronephrosis was revealed by CT scan and she was diagnosed as right pyelonephritis with ureteral obstruction due to the uterine mass. Right ureteral stent placement was performed and antibiotic treatment was started. The uterine mass was diagnosed as actinomycosis of the uterus by the bacterial culture. Antibiotic treatment was continued for two months and the actinomycotic lesion was shrunk, although there was recurrent actinomycosis four weeks after discontinuation of antibiotics. At that time, left hydronephrosis and intestinal obstruction were revealed by CT scan and left ureteral stent and nasogastric tube indwelling were performed. After additional four months of antibiotic treatment, the actinomycotic lesion disappeared and the bilateral ureteral stents were removed. For us, urologist, it is necessary to keep in mind an opportunity of actinomycosis of the uterus diagnosing pelvic tumors (Rinsho Hinyokika 74 : 245-248, 2020).