宇野 矢紀¹, 成田 晃貴¹, 加藤 早苗¹, 吉野 裕美¹, 竹中 恵美¹, 舩田 朋子¹, 永田 純子¹, 井内 幹人², 田中 仁², 那須 通寛²

Naoki UNO¹, Kouki NARITA¹, Sanae KATO¹, Yumi YOSHINO¹, Emi TAKENAKA¹, Tomoko FUNADA¹, Junko NAGATA¹, Mikito INOUCHI², Jin TANAKA², Michihiro NASU²

¹豊岡病院組合立公立豊岡病院検査技術科, ²豊岡病院組合立公立豊岡病院呼吸器・心臓血管外科

¹Department of Inspection Technology,Toyooka Public Hospital, ²Department of Cardiovascular Surgery,Toyooka Public Hospital

キーワード : aortic infective endocarditis, coronary artery embolism, cerebral infarction, iliopsoas muscle abscess, shoulder abscess

症例は70代男性．変形性腰椎症に対し硬膜外ブロック注射を4年前から月に1回定期施行していた．入院2日前から多発性関節痛と38.0℃の発熱を認め受診，高度な炎症反応と全身CTで右肩・右腸腰筋に膿瘍像，頭部MRIで左前頭葉に梗塞像を認め感染性心内膜炎を疑い入院となった．入院当日と入院2日目の血液培養からメチシリン耐性黄色ブドウ球菌が検出，その後の経胸壁心臓超音波検査で大動脈弁左室側に紐状の疣腫像と前壁中隔の壁運動低下を認めた．入院3日目に経食道心臓超音波検査で大動脈弁に疣腫像を認め感染性心内膜炎と確定診断，同日施行された冠動脈CTでは左前下行枝に疣腫によると思われる高度狭窄像を認めた．入院4日目に準緊急手術（大動脈弁置換術，冠動脈バイパス術）が施行された．肩・腸腰筋膿瘍を契機とした感染性心内膜炎に非典型的な疣腫による冠動脈塞栓，脳梗塞を合併した症例を経験したので報告する．

This case involved a man in his 70s who had been receiving regular epidural block injections for lumbar spondylosis once a month for 4 years. Two days before hospitalization, he presented with polyarthralgia and a body temperature of 38.0℃. An examination suggested a severe inflammatory reaction. Whole-body computerized tomography (CT) indicated an abscess in the right shoulder and right iliopsoas muscle, whereas cranial magnetic resonance imaging indicated an infarction in the left frontal lobe. Infective endocarditis was suspected, leading to the patient's admission to the hospital. Methicillin-resistant Staphylococcus aureus was detected in his blood culture on days 1 and 2 of hospitalization. Subsequent transthoracic echocardiography indicated string-like vegetation on the left ventricular side of the aortic valve and hypokinesis of the anterior septal wall. On day 3 of hospitalization, transesophageal echocardiography showed vegetation on the aortic valve, leading to a definitive diagnosis of infective endocarditis. Coronary CT performed the same day demonstrated severe stenosis in the left anterior descending artery, possibly caused by vegetation. On day 4 of hospitalization, the patient underwent semi-emergency surgery involving aortic valve replacement and coronary artery bypass surgery. This was a case of infective endocarditis caused by abscesses in the shoulder and iliopsoas muscle, which was complicated by coronary artery embolism caused by atypical vegetation and cerebral infarction.