肝膿瘍，腹壁膿瘍に化膿性椎間板炎，腸腰筋膿瘍を合併した関節リウマチの1例

Liver and Abdominal Wall Abscess Complicated with Pyogenic Discitis and Iliopsoas Abscess in a Rheumatoid Arthritis Patient. Case Report

　肝膿瘍，腹壁膿瘍に化膿性椎間板炎，腸腰筋膿瘍を合併した関節リウマチ（RA）の1例を経験した．症例は72歳のRAの男性．右下腹部の発赤，熱感，右大腿部痛が出現した．CT，MRIにて肝膿瘍，腹壁膿瘍，両側腸腰筋膿瘍，L3/4の化膿性椎間板炎を認めた．経皮的ドレナージを5回行ったが，起炎菌が同定されず，徐々に全身状態が悪化し，肺炎にて死亡した．Compromised hostの場合，膿瘍治療において，全身状態を考慮しながら，より早期に積極的な観血的治療が必要な場合もあると考えられた．

　We report a case of liver and abdominal wall abscess complicated by pyogenic discitis and iliopsoas abscess in a rheumatoid arthritis patient. The 72-year-old man, who had taken 17.5mg of prednisolone daily reported redness of the lower right abdomen, heat, and right thigh pain. CT and MRI results showed liver and abdominal wall abscess, pyogenic discitis, and iliopsoas abscess. We treated these by percutaneous drainage in pyogenic discitis and iliopsoas abscess 5 times, without success. Bacteria were not detected from pus, so no antibiotic had been prescribed for the patient. He died of pneumonia 3months later. In a compromised host suffering from abscesses, it is important to undertake surgical drainage immediately upon diagnosis, taking into account the patient's general condition.