化膿性胸鎖関節炎合併大動脈弁位感染性心内膜炎に対して低侵襲大動脈弁置換術を施行した1例

Minimally Invasive Aortic Valve Replacement for Aortic Valve Infective Endocarditis Complicated by Septic Arthritis of the Sternoclavicular Joint：Report of a Case

はじめに　アトピー性皮膚炎（AD）を背景に発症する感染性心内膜炎（IE）はまれであるが経験する．特に皮膚病変や手術部位近傍の膿瘍を合併した場合，IEに対する心臓手術のアプローチ法に検討を要する．われわれはADを背景に発症した化膿性胸鎖関節炎合併大動脈弁位IEに対する手術例を経験したため，文献的考察を加え報告する．

A 54-year-old man with a history of atopic dermatitis was admitted to our hospital for persistent fever and multiple arthralgias unresponsive to antibiotics. On the second day of hospitalization, Staphylococcus aureus was detected in the blood culture, and debridement for presumed pyogenic arthritis was performed on the patient’s bilateral wrists and right ankle joints. Echocardiography showed evidence of infective endocarditis of the aortic valve. The patient’s fever persisted after drainage of multiple joint abscesses, and blood cultures remained positive. A right sternoclavicular joint abscess that had been noted on computed tomography （CT） at the time of admission had not decreased in size on repeat CT performed 10 days post-admission. After additional drainage of the sternoclavicular joint abscess on the 15th day, the patient’s fever subsided, and blood culture was negative. On the 29th day, an aortic valve replacement was performed via a right anterior thoracotomy to prevent sternal osteomyelitis. The postoperative course was uneventful, and the patient was discharged on the 35th day after valve surgery. One year after the surgery, he continues to take antibiotics, and recurrence of infection has not been observed.