化膿性脊椎炎を合併した感染性心内膜炎の治験例  [in Japanese] A Case of Infective Endocarditis and Osteomyelitis  [in Japanese]

患者は53歳の男性で腰痛と呼吸困難を主訴として来院した.心エコー図検査と腰部MRI検査で感染性心内膜炎による僧帽弁閉鎖不全・化膿性脊椎炎と診断された.化膿性脊椎炎はペニシリン系抗生剤,アミノグリコシド系抗生剤投与による保存的療法により軽快したが,利尿剤などの投与によっても心不全が軽快せず僧帽弁置換術を施行した.術前の動脈血や切除弁培養で起因菌を同定することができなかったが,セフェム系抗生剤の投与を術後6週間行った.術後18カ月の現在脊椎炎などの再発はみられず,経過順調である.

A 53-year-old man was admitted to Jichi Medical School Hospital because of low back pain and respiratory distress. Echocardiography revealed mitral valve regurgitation and mitral vegetations, and MR imaging showed destructive change in the lumbar vertebrae. The low back pain and inflammatory activity subsided with administration of antibiotics, but regurgitation-induced heart failure was medically intractable. The patient underwent mitral valve replacement with a bicarbon valve. The mitral valve showed destructive change with infective vegetation. Microbiologic study of preoperative blood samples and resected valve did not show any organism. Antibiotics were given for another 6 weeks. As of the last follow-up observation at 18 months, the patient was doing well.