MRSAによる頸髄硬膜外膿瘍の1例

Cervical Spinal Epidural Abscess Caused by Methicillin-Resistant Staphylococcus Aureus (MRSA)

I．はじめに

　頸髄硬膜外膿瘍は比較的稀な感染症であるが，その大部分が胸髄に発症し，頸髄に発生するものは非常に少ない．一方メチシリン耐性黄色ブドウ球菌（MRSA）感染症は近年増加しており，また多剤耐性の性格を持つため治療困難であり，現在臨床上大きな問題となっている．今回われわれは急性腎不全で発症し，血液透析カテーテルより検出されたMRSAが血行性に頸椎および頸髄硬膜外腔へ波及し，頸髄硬膜外膿瘍を呈したと思われる稀な1症例を経験したので若干の文献的考察を加えて報告する．

Epidural abscess is an uncommon infectious disease. The cervical spine is the least frequent site of spinal epidural abscess. It has been reported that early dia-gnosis and surgical treatment prevent neurological de-ficit, but it is difficult to diagnose this disease clinically. We presented a rare case of cervical epidural abscess caused by MRSA.

A 54-year-old man was admitted to our hospital because of acute renal failure and hepatitis. He was treated with hemodialysis via the femoral route. His re-nal function recovered but high fever continued. MRSA was identified from the AV shunt catheter. He noted pain and dysesthesia on his left shoulder one month af-ter admission. He was transferred to our department with suspect of spinal tumor. Neurological examination demonstrated left hemiparesis with superficial sensory disturbance between C8 and Th2. Cervical CT scan showed osteomyelitis at the left C7 lamina and facet. MR imaging disclosed that an epidural mass at C7 had low signal intensity on T1 weighted and high sig-nal intensity on T2 weighted and ring-like enhancement with gadolinium. He was treated conservatively for a month. Sequential MR imaging showed the mass had homogeneous enhancement at C7 epidural space ex-tending to the left intervertebral foramen. Laboratory examination showed normal. The patient was dia-gnosed as having cervical epidural abscess. A C6 through Th2 laminectomy and C8 foraminotomy were performed and an encapsulated abscess including yel-lowish pus was totally removed. The pathological dia-gnosis was non-specific abscess in the subacute stage. MRSA was identified by the intraoperative pus culture. After the surgery, antibiotics were administered. On the first postoperative day, left sensory disturbance was im-proved. He was discharged one month after surgery. MR imaging is useful for the detection of a cervical epidural abscess, and in evaluating the exact anatomical location of such an abscess.