膿腎症から進展した脾膿瘍の1例

Abstract

58歳女.主訴は発熱と上腹部痛であった.尿検査で高度な膿尿を認めた.腹部CTでは左腎に珊瑚状結石, 左腎上極から外側周囲に広がる不均質に造影される腫瘤影と脾実質に多発する嚢胞性病変を認めたため, 珊瑚状結石に伴う膿腎症, 腎周囲腫瘍および脾膿瘍と診断した.SBC/CPZによる単独治療で主訴症状が改善した.その後, 経過観察していたが脾膿瘍の消退を認めた.しかし, 8ヵ月後に左無機能腎となったため, 左腎摘除術を施行した.術後再発は認めない.珊瑚状結石を伴う膿腎症が関連疾患となった脾膿瘍症例は非常に稀である

We report a rare case of splenic abscesses that were derived from left pyonephrosis. A 58-year-old woman was referred to our hospital with complaints of fever and epigastralgia. Computed tomography revealed splenic abscesses and left pyonephrosis with staghorn calculi. After admission, her condition improved with conservative therapy. Eight months later, the splenic abscesses had disappeared. The patient was then readmitted and left nephrectomy was performed to prevent relapse of the splenic abscesses. We suspected that direct invasion of inflammation from the left pyonephrosis caused the splenic abscesses, as her left kidney had adhered to the spleen. Only one case of splenic abscesses derived from a urinary tract infection has been reported in Japan.