巨大滑液嚢腫を伴った股関節結核の一例

Abstract

This case involves an 81-year-old woman. The patient's medical history indicates radiation therapy for uterine cervical cancer 15 years ago. Subsequent metastasis to the lungs occurred ten years ago, and lobectomy was performed. Pyrexia in the right coxalgia was found about a half year ago during check up. She had been given antibiotics for the treatment of osteomyelitis at a previous hospital, but the condition in the right coxalgia lingered in greater and lesser degrees alternately. In the initial diagnosis, we observed that range-of-motion was restricted in the right hip joint, and X-ray examination showed Otto innominate bone deformation. Combined computed tomography and MRI examinations indicated giant cystic lesions extending to the lesser trochanter from the iliacus muscle of the iliac fossa. Bone scintigram examination showrd aberrant accumulation in the right acetabular roof, right femoral head, and trochanter. Tuberculin reaction was negative in two tests. There were no unusual findings in conventional chest X-ray examination. Articulatio simplex type rheumatoid arthritis, coxotuberculosis, osteomyelitis, and metastatic bone tumor were considered from the above observations. We performed puncture on the fourth day of hospitalization and diagnosed coxotuberculosis in a polymerase chain reaction. Treatment of the hip in which the joint space had been destroyed consisted of radical decompression, drainage of abscess, and removal of avascular tissues. This was followed by antituberculosis chemotherapy with multiple drugs until there was clinical and hematological evidence.