感染性心内膜炎が原因で発症した腎梗塞, 腎膿瘍の1例

Abstract

68歳男。主訴は発熱・右腰部痛であった。拡張期心雑音を聴取し, 血液生化学検査で高度炎症所見およびLDH, ALPの上昇を認めた。腹部造影CTでは右腎下極の腎梗塞と, 腎梗塞内部・肝臓・脾臓に膿瘍を認めた。心臓超音波検査にて大動脈弁に疣贅を認めたため, 疣贅を伴う感染性心内膜炎および疣贅塞栓による腎梗塞と診断で緊急大動脈弁置換術を施行した。血液培養にてEnterococcus faecalisを検出したため抗生剤をアンピシリンおよびゲンタマイシンに変更し, 2週間の点滴にて血液生化学検査上炎症所見の改善を認めた。また, 右腎梗塞および多発性膿瘍は術後3ヵ月後のCTにて消失が確認され, 術後15ヵ月の時点で感染性心内膜炎や腎梗塞, 腎膿瘍の再燃は認めていない。

A 68- year-old male was referred with fever and urinary tract infection. Abdominal computed tomography showed a right renal infarction with abscess and abscesses in the liver and spleen. Cardiac ultrasonic examination showed a vegitation in the aortic valve. Based on these findings, the patient was diagnosed with infective endocarditis and multiple abdominal organ abscesses. The renal infarctions and multiple abscesses probably developed due to dissemination of warts associated with infective endocarditis. We performed emergency valve replacement at the cardiovascular surgery unit at our hospital. Improvements were made in the multiple abscesses after subsequent treatment with an antibiotic agent. The renal diseases associated with infective endocarditis were found to be diverse and we concluded that it is important to understand the conditions of the disease correctly for appropriate treatment.