経尿道的前立腺切除術後にEnterobacter cloacaeによる化膿性脊椎炎を来たした1例

Abstract

79歳男.前立腺肥大症と診断され, 内服治療を行ったが, 排尿悪化に伴い経尿道的前立腺切除術(TURP)を椎麻酔下で施行した.術後の著明な出血により術後7日目に尿道カテーテルを抜去したが39～40℃の発熱が持続し, E.cloacae, MRSAの検出をみた.9日目より腰痛を自覚しMRIでL4～5椎間腔の狭小化を認め, 腰痛症又は腰椎ヘルニアを疑うが脊椎炎の所見は認めなかった.imipenem(IPM), teicoplanin(TEIC)を2週間CRPは陰性化しなかったが解熱, WBC低下と血液・尿培養の陰性化を受け, galifloxacin(GFLX)に変更したが再び発熱とWBC, CRPが上昇し, 腰痛悪化で歩行困難となった.Gaシンチ施行により術後39日目に化膿性背椎炎と診断し, E.cloacaeが検出された.3週間治療内服後CRPの陰性化, 腰痛は軽減し歩行可能となり術後6ヵ月目に退院した

We report a case of pyogenic spondylitis caused by Enterobacter cloacae as a rare complication of transurethral resection of the prostate (TURP). A 79-year-old man underwent TURP. Immediate after removal of urethral catheter on postoperative day (POD) 7, he developed high fever > 40 degrees C with increased acute inflammatory reaction. Urine and blood culture detected E. cloacae and methicillin-resistant Staplylococcus aureus. He complained of lumbago since POD 9. Two-week administration of imipenem and teicoplanin resulted in resolution of fever as well as laboratory data, so intravenous antibiotics were changed to oral gatifloxacin. However, his lumbago worsened and gait disturbance appeared. On POD 39, diagnosis of pyogenic spondylitis was finally obtained by Ga-scintigraphy and magnetic resonance imaging. Aspiration of the intervertebral disk (L4-5) revealed E. cloacae as the causative organism of pyogenic spondylitis. His condition improved after conservative treatment with teicoplanin, meropenem and ciplofloxacin for 9 weeks.