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静脉吸毒者中与感染性腹主动脉瘤相邻的腰椎间盘炎。

lumbar spondylodiscitis contiguous to infected abdominal aortic aneurysm in an intravenous drug user.

作者信息

Yamada Tsuyoshi, Shindo Shigeo, Otani Kazuyuki, Nakai Osamu

机构信息

Department of Orthopaedic Surgery, Kudanzaka Hospital, Tokyo, Japan

Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.

出版信息

BMJ Case Rep. 2021 Apr 14;14(4):e241493. doi: 10.1136/bcr-2020-241493.

Abstract

While the incidence of spondylodiscitis is rising because of longer life expectancy and the increasing use of immunosuppressant drug, indwelling devices and spinal surgeries, the fungal aetiology remains rare, sometimes affecting intravenous drug users. spondylodiscitis is an extremely rare complication post aortic aneurysm repair. It is potentially fatal due to the risk of aneurysm rupture and septic complications. The growing problem of systemic diseases caused by species reflects the enormous increase of patients at risk. The treatment of this complicated entity is challenging and often requiring a multidisciplinary team. We reported the rare case of spondylodiscitis contiguous to infected aortic aneurysm in a 74-year-old male intravenous drug user, to the extent which the vertebral body bony destruction progressed to need one-stage posterior and anterior spinal fusion surgery with curettage. Our surgical intervention combined with prolonged course of antifungal therapy could successfully eradicate the infection and resolve the neurological deficits.

摘要

由于预期寿命延长以及免疫抑制药物、留置装置和脊柱手术的使用增加,脊椎椎间盘炎的发病率正在上升,但真菌病因仍然罕见,有时会影响静脉吸毒者。脊椎椎间盘炎是主动脉瘤修复术后极为罕见的并发症。由于存在动脉瘤破裂和感染并发症的风险,它可能是致命的。由该菌种引起的全身性疾病问题日益严重,反映出高危患者数量大幅增加。治疗这种复杂病症具有挑战性,通常需要多学科团队。我们报告了一例罕见病例,一名74岁男性静脉吸毒者发生与感染性主动脉瘤相邻的脊椎椎间盘炎,椎体骨质破坏进展到需要进行一期后路和前路脊柱融合手术并刮除病灶。我们的手术干预与延长疗程的抗真菌治疗相结合,成功根除了感染并解决了神经功能缺损问题。

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