仙腸関節炎を初発症状とした感染性心内膜炎の1症例 A case of infective endocarditis with buttock pain as a unique initial symptom

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仙腸関節炎を初発症状とした感染性心内膜炎(IE)の1例を経験した。<br>患者は18歳女性。覚醒剤の使用開始から2ヵ月後に40℃の発熱を認め,3ヵ月後に著しい臀部痛のため起立不能となり複数の病院で抗生物質治療を受けた。5ヵ月後に前医によって腰部CT検査で仙腸関節の炎症像,血液培養にてγ-<i>Streptococcus</i>を認め,化膿性仙腸関節炎による敗血症,多臓器不全と診断され当院へ転院となった。来院時は全身性炎症反応症候群,うっ血性心不全,急性腎不全を呈し,心臓超音波検査では三尖弁の疣贅形成と閉鎖不全(TR)II°を認めた。われわれはIEによる敗血症と診断しペニシリンG大量療法を開始した。約1ヵ月で検査所見,自覚症状は改善し,三尖弁形成術を施行され入院5ヵ月後に退院となった。<br>IEの25~44%に筋骨格症状を認めるが,本症例のような仙腸関節部痛は稀である。IEの危険因子である薬物乱用が増加しており,不明熱,関節痛の原因としてIEに着目する必要がある。

The patient was an 18-year-old female. About two months after beginning of illegal self-administration of psychostimulants, she developed fever of 40°C and was treated symptomatically at several institutes. Three months later, severe buttock pain on the left disabled her to stand up but two more months were needed to get diagnosed as pyrogenic sacroiliitis with sepsis. A CT scan detected inflammatory change in the left sacroiliac joint and γ-<i>Streptococcus</i> was cultured from a blood sample. Intravenous piperacillin was started, however, she developed congestive heart failure and transferred to our critical care medical center after all. The patient was in systemic inflammatory response syndrome with congestive heart failure and renal dysfunction upon arrival and echocardiography revealed tricuspid regurgitation (TR). Diagnosed as infective endocarditis (IE), she was administered 24 million units of Penicillin G per day as an initial dose. Her body temperature, white blood cell count, C-reactive protein, and serum creatinine values were gradually normalized within a month and her buttock pain was also disappeared. Valvoplasty was done in the 4th month for TR and she was discharged in 5th month. Although musculoskeletal symptoms appear in 25-44% of IE in previous reports, most of them are low back pain and buttock pain in the present case is extremely rare. IE resulting from drug abuse is increasing in number, therefore, clinicians should pay attention to those who manifest arthralgia and fever of unknown origin.

収録刊行物

  • 日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine

    日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine 9(2), 135-138, 2002-04-01

    The Japanese Society of Intensive Care Medicine

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各種コード

  • NII論文ID(NAID)
    10008940515
  • NII書誌ID(NCID)
    AN10474053
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13407988
  • データ提供元
    CJP書誌  J-STAGE 
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