胸部大動脈解離術後の人工血管感染により椎骨-脳底動脈領域に限局する多発脳膿瘍を呈した1例

Multiple Brain Abscesses in the Territory of the Vertebral-Basilar Artery Resulting from an Infected Aortic Arch Graft

Ⅰ．はじめに

　脳膿瘍の感染経路には，脳に隣接した組織（中耳，副鼻腔，口腔など）からの直接感染⁹⁾や，肺・心臓・腹部あるいは骨盤内臓器からの血行性感染などが知られている．今回，胸部大動脈解離に対して使用した人工血管が感染源となり，椎骨-脳底動脈領域に限局した多発脳膿瘍を呈した稀な症例を経験したので報告する．

　A 62-year-old man with high fever and in a state of disorientation was transferred to our hospital. One year before this transfer, he had undergone total arch replacement surgery for thoracic aortic dissection. On admission to our hospital, head MRI revealed multiple brain abscesses in the territory of the vertebral-basilar artery, and chest CT showed gas around the aortic graft, in particular, at the origin of the left subclavian artery. We diagnosed him with brain abscesses in the left vertebral-basilar artery resulting from an infected aortic graft. We immediately began administration of intravenous antibiotics. Although his blood, urine, and cerebrospinal fluid cultures were negative, fortunately, the brain abscesses and ectopic gas disappeared. Since reports of only antibiotic use for treating brain abscesses due to aortic graft infection are rare, the appropriate duration of antibiotic administration has not been established yet. Therefore, careful observation is required in this case.