Ota Koshi, Onishi Naoya, Fujii Kensuke, Nakamura Eriko, Oishi Yasuo, Oka Masahiro, Ota Kanna, Sano Yohei, Yokoyama Hiroki, Takasu Akira
Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan.
Nonaka Clinic, Osaka, Japan.
SAGE Open Med Case Rep. 2020 Aug 23;8:2050313X20952996. doi: 10.1177/2050313X20952996. eCollection 2020.
A 77-year-old man presented to the emergency room with a 1-month history of persistent low back pain with the absence of vital sign abnormalities. On several previous orthopedic surgery clinic visits, pathological back pain had not been considered and pain killers had been prescribed because he had low back pain due to lumbar spinal canal stenosis. He was admitted to the intensive care unit for infectious spondylodiscitis and infective endocarditis with disseminated abscess caused by methicillin-resistant . Shock refractory tachyarrhythmia could not be managed with antiarrhythmic agent in the intensive care unit. Intractable low back pain and persistent tachyarrhythmia were adequately managed by pain control with fentanyl in the intensive care unit. Infectious spondylodiscitis and infective endocarditis were effectively managed with anti-methicillin-resistant drugs, initially in rotational usage, but the patient died of extended-spectrum beta-lactamase-producing pneumonia on day 50 of hospitalization. Infectious spondylodiscitis should have been considered for persistent low back pain with hemodialysis, fever, and a history of device implantation. Pain management may be necessary for persistent tachycardia that proves unresponsive to usual antiarrhythmic medications.
一名77岁男性因持续1个月的下背部疼痛就诊于急诊室，生命体征无异常。此前在骨科手术门诊多次就诊时，未考虑病理性背痛，因腰椎管狭窄导致下背部疼痛而开具了止痛药。他因耐甲氧西林金黄色葡萄球菌引起的感染性脊椎椎间盘炎、感染性心内膜炎伴播散性脓肿入住重症监护病房。在重症监护病房，抗心律失常药物无法控制休克难治性快速心律失常。在重症监护病房，通过芬太尼控制疼痛，有效缓解了顽固性下背部疼痛和持续性快速心律失常。感染性脊椎椎间盘炎和感染性心内膜炎最初通过轮流使用抗耐甲氧西林金黄色葡萄球菌药物得到有效治疗，但患者在住院第50天死于产超广谱β-内酰胺酶肺炎。对于伴有血液透析、发热和器械植入史的持续性下背部疼痛，应考虑感染性脊椎椎间盘炎。对于对常规抗心律失常药物无反应的持续性心动过速，可能需要进行疼痛管理。
