ペニシリン注射後の結核性仙腸炎．症例報告

Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report.

• Mohammad Darvishi
• Sana Rashidi
• Setayesh Abazari

抄録

結核は、骨や関節などの様々な臓器に影響を及ぼす発展途上国の主要な健康問題の一つである。変形性関節性結核の最も重要な関与部位の一つは仙腸関節である。さらに、その発生率はここ数年で増加しています。神経学的合併症や外科的合併症など、さらなる障害を予防するためには早期診断が必要である。ペニシリン注射後に発症した右仙腸関節結核性関節炎の1例を報告する。患者は32歳の男性で，イラン，テヘランのBesat病院に入院した．彼は約17年前にペニシリン注射後、黄色の分泌物を伴う開口部が出現した後、右臀部の痛み、紅斑、腫脹を訴えていた。その後も数年の間に分泌物は続いたが、痛み、腫れ、紅斑は消失した。入院時のバイタルサインは安定しており、正常であった。身体検査では本人の主張通り右臀部に少量の黄色い分泌物を伴うオリフィスが認められた。肺聴診では異常なし。リンパ節腫脹は認められなかった。臨床検査値は正常であった。入院中に抗生物質の初期治療が行われた。培養検査で結核が検出されたため，ビタミンB6とパントプラゾールを毎日投与したほか，リファンピン，イソニアジド，エタンブトール，ピラジンアミドの4剤併用療法が18～24ヵ月間処方された．

Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection. The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal. During hospitalization, initial antibiotic therapy was prescribed. After was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18-24 months, in addition to daily vitamin B6 and pantoprazole.

学習ポイント:

結核が確認された後、毎日のビタミンB6、パントプラゾールに加えて18～24ヶ月間の4剤併用抗結核薬治療が行われた。

LEARNING POINTS: After confirmation of tuberculosis (TB), a 4-drug anti-TB therapy was administered for 18-24 months, together with daily vitamin B6 and pantoprazole.After 2 years of follow-up, MRI showed significantly reduced signal intensity of bone and soft tissue, but the size of the complex did not change in the sacroiliac joint.

© EFIM 2020.