Harries Luke William, Watura Roland
Medical School, Queens Medical Centre, Nottingham, UK.
BMJ Case Rep. 2012 Apr 2;2012:bcr0920114849. doi: 10.1136/bcr.09.2011.4849.
A 40-year-old female patient presented with persistent severe back pain radiating to the right leg, abdominal pain and constipation. Other clinical symptoms included nausea, vomiting and high-grade fever. Clinical examination showed generalised abdominal and lower back tenderness. There was no sensory loss or motor weakness in lower limbs, however investigations showed raised inflammatory markers. Radiographs of the lumbar spine and hip joint were normal. MRI revealed a septic arthritis of the right L3/4 facet joint, associated with a large abscess extending anteriorly to the right paraspinal muscles and posteriorly into the right posterolateral aspect of the epidural space in the central spinal canal, with moderate compression of the dural sac. Unlike any other reported similar case, this septic arthritis developed without prior medical intervention. The patient was treated successfully with ultrasound guided drainage of the facet joint/abscess and antibiotics.
一名40岁女性患者出现持续严重的背痛并向右腿放射，伴有腹痛和便秘。其他临床症状包括恶心、呕吐和高热。临床检查发现全腹及下背部压痛。下肢无感觉丧失或运动无力，但检查显示炎症指标升高。腰椎和髋关节X线片正常。磁共振成像（MRI）显示右侧L3/4小关节化脓性关节炎，伴有一个大脓肿，向前延伸至右侧椎旁肌肉，向后进入中央椎管硬膜外间隙的右后外侧，硬膜囊中度受压。与其他任何已报道的类似病例不同，该化脓性关节炎在未进行前期医学干预的情况下发生。患者通过超声引导下小关节/脓肿引流及抗生素治疗成功。
