Ujihara Masaki, Kobayashi Masahito, Yamaguchi Hiroshi, Hirata Sachiko, Takabatake Kazuhiko, Wakiya Kenji, Sasaki Atsushi, Fujimaki Takamitsu
Department of Neurosurgery, Saitama Medical University, Moroyama-machi, Saitama, Japan.
Department of Pathology, Saitama Medical University, Moroyama-machi, Saitama, Japan.
NMC Case Rep J. 2022 Nov 9;9:383-388. doi: 10.2176/jns-nmc.2022-0199. eCollection 2022.
We report an 18-year-old female patient who developed left temporal headache and fever one month after administration of isotretinoin for acne. Imaging studies demonstrated osteolytic change in the left frontal bone, and the lesion showed gadolinium contrast enhancement. Biopsy confirmed the diagnosis of osteomyelitis, and the symptoms improved after 8 months of medication with antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). However, the pain recurred when isotretinoin was resumed. Isotretinoin sometimes causes excessive inflammation, which may have been the reason for the osteomyelitis in this case. Although osteomyelitis is usually caused by bacterial infection, a non-bacterial mechanism should also be suspected if the condition is resistant to antibiotics.
我们报告一名18岁女性患者，她在服用异维A酸治疗痤疮一个月后出现左侧颞部头痛和发热。影像学检查显示左侧额骨有骨质溶解改变，病变有钆对比增强。活检确诊为骨髓炎，经使用抗生素和非甾体抗炎药（NSAIDs）治疗8个月后症状改善。然而，当重新服用异维A酸时疼痛复发。异维A酸有时会引起过度炎症，这可能是本例骨髓炎的原因。虽然骨髓炎通常由细菌感染引起，但如果病情对抗生素耐药，也应怀疑非细菌机制。
