ステロイド治療中に下腿の化膿性筋炎を発症した透析患者の１例

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  • Crural pyomyositis in a hemodialysis patient receiving corticosteroid therapy
  • ショウレイ ホウコク ステロイド チリョウ チュウ ニ カタイ ノ カノウセイ キンエン オ ハッショウ シタ トウセキ カンジャ ノ 1レイ

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We report here a rare case of crural pyomyositis in a hemodialysis patient receiving corticosteroid therapy. The patient was a 70-year-old man who had been on hemodialysis since December, 1997 due to diabetic nephropathy. On May, 2004, he was admitted to our hospital because of fever, right chest pain, and right pleural effusion. After admission, pleuritis due to autoimmune reaction was suspected because of positive antinuclear antibody, LE cells, and exudative pleural effusion. Oral administration of prednisolone (40mg/day) was initiated, and pleuritis was gradually improved. Two weeks after starting steroid therapy, the patient suddenly developed right leg pain and fell into shock. Group G streptococcus was positive on cultures of soleus, blister effusion and blood. MRI showed diffuse soleus enlargement and increased signal intensity on T2-weighted image. We diagnosed to be crural pyomyositis. Treatment with ampicillin 2g/day was initiated and 2 weeks later pyomyositis was improved. We assumed that toxic shock-like syndrome was complicated by pyomyositis with group G streptococcus during steroid therapy. When hemodialysis patients develop leg pain, pyomyositis should be considered.

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