肺サルコイドーシスの治療経過中に胸椎カリエスを併発した1例

A Case of Thoracic Vertebral Tuberculosis Associated with Pulmonary Sarcoidosis

I．はじめに

　脊椎サルコイドーシスと脊椎カリエスは，画像上類似することもあり診断に苦慮することがある^3）．今回，われわれは肺サルコイドーシス治療中に胸椎カリエスを併発した1例を経験した，その診断から治療までの経過の中で，反省点も含め報告したい．

A 56-year-old woman was admitted to our hospital, on October 10, 1999 because of tingling numbness of the Th3 area and paraparesis. Her medical history included the diagnosis of pulmonary sarcoidosis which had responded to steroid therapy. On radiographic examination, a Th2 compression fracture and gadoli-nium enhanced areas were shown in MRI. We diagnosed vertebral sarcoidosis and restarted steroid the-rapy. Next day, she had no paresis and she was discharged after 20 days. However, the patient returned to our hospital with recurrence of the same pain and paraparesis on January 1, 2000, and spinal fusion of the Th2-3 was performed by a transpleural anterolateral approach using a block of iliac bone as a graft. Histol-ogy and cultural studies of tissue revealed tuberculosis. There is a diagnostic dilemma, “sarcoidosis or tubercurosis?”, but it is necessary to be aware of this at the time of the initial diagnosis.