若年者にみられた腸腰筋冷膿瘍

Abstract

症例は28歳男性で, 4ヵ月ほど前からの右側背部痛と持続的な微熱および右陰嚢内有痛性腫瘤を主訴に近医を受診, 右精巣上体炎の診断で入院となった.腹部CTで右腸腰筋に腫瘍を指摘され, 喀痰培養検査で結核菌陽性を示したため紹介来診し, 肺結核, 右結核性精巣上体炎および右腸腰筋冷膿瘍の診断で入院となった.エタンブトール, リファンピシン(REP), イソニアジド(INH)の3剤併用療法の施行では発熱が持続するためストレプトマイシン, ピラジナミド, REP, INHの4剤併用療法に変更した.さらに右腸腰筋膿瘍に超音波ガイド下で経皮的ドレナージを施行したところ症状が著明に改善した.炎症所見の低下傾向とCT上も膿瘍の消失を認めドレナージチューブを抜去したが, 約2ヵ月後に冷膿瘍再発を認め, 再度ドレナージを施行した.約5ヵ月後の腹部CTで右腸腰筋膿瘍の縮小, 瘢痕化を認め, ドレナージチューブを抜去した.その後も化学療法を継続し, 再燃を認めなかったため入院より約1年半後に退院となり, 外来にて経過観察中である

A 28-year-old man was referred to our hospital with a complaint of painful induration of right epididymis accompanied with right back pain and persistent low-grade fever. He was finally diagnosed with tuberculosis by sputum culture. Abdominal computed tomography (CT) revealed right psoas abscess and vertebral caries. He underwent a percutaneous drainage of the abscess followed by multidrug (streptomycin, pyrazinamide, refanpicin, isoniazide) combination therapy. Immediately after the drainage, symptoms began to improve with these therapies. However, four months later, abdominal CT showed a worsening of the abscess. Recently there is a stagnation in the decline of incidence of tuberculosis. It is still necessary to examine young people carefully bearing urogenital tuberculosis in mind. The pathogenesis and management of this rare condition are discussed.