重症歯周炎が原因と考えられた頚髄髄内膿瘍の1例

Intramedullary Abscess of the Cervical Spinal Cord Caused by Advanced Periodontitis:Case Report

Ⅰ．はじめに

　脊髄髄内膿瘍は比較的稀な疾患であり，膿瘍の原因としては感染性心内膜炎などによる血行感染や脊柱管内皮膚洞などからの直接感染がある．今回われわれは，重症歯周炎による血行感染が原因と思われる頚髄髄内膿瘍の稀な1例を経験したので，若干の文献的考察を加え報告する．

　We describe the case of a 60-year-old man with an intramedullary abscess of the cervical spinal cord caused by advanced periodontitis. He suddenly developed severe neck pain and rapidly progressive palsy of the left upper arm. T2-weighted sagittal magnetic resonance imaging（MRI）revealed a hyperintense area extending from C1 to C6. Gadolinium-enhanced T1-weighted MRI showed a ring-enhanced lesion at the C3-4 level that was hyperintense on diffusion-weighted MRI. The patient underwent drainage of the abscess through laminectomy. Cultures of the abscess contents revealed Fusobacterium nucleatum and Peptostreptococcus micros. Antibiotics administered to the patient to treat the infection with these anaerobic bacteria improved the neurological deficit eight weeks after surgery. The patient was also diagnosed with advanced periodontitis due to Fusobacterium nucleatum that might have caused the intramedullary abscess of the cervical spinal cord.