Vertebral Osteomyelitis Due to MAC / C. Yamamoto et al. 353 Tubercle. 1986 ; 67 : 229 232. 13) 宮崎幸政, 菊池直士, 井上三四郎, 他:非定型抗酸菌に よる感染性脊椎炎の 2 例. 整形外科と災害外科. 2012 ; 61 (4) : 669 673. 14) 中川真一, 藤森孝人, 渋谷高明, 他:L5/S非結核性抗酸 菌性脊椎炎に対し腰椎前方固定術を施行した 1 例. 中 部整災誌. 2017 ; 60 : 647 648.

15) Wong NM, Sun LK, Lau PY: Spinal infection caused by Mycobacterium avium complex in a patient with no aquired immune defi ciency syndrome: a case report. Journal of Orthopaedic Surgery. 2008 ; 16 : 359 363.

16) Higuchi T, Takahashi N, Yoshikawa H, et al.: Spinal osteomyelitis due to Mycobacterium avium-intracellulare: MR fi ndings. Internet J Radiol. 2005 ; 5 (1).

17) Lee Y, Kim B-J, Kim S-H, et al.: Comparative Analysis of Spontaneous Infectious Spondylitis : Pyogenic versus Tuberculous. J Korean Neurosurg Soc. 2018 ; 61 (1) : 81 88. 18) Berbari EF, Kanj SS, Kowalski TJ, et al.: 2015 Infectious

Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Teratment of Native Vertebral Osteomyelitis in Adults. CID. 2015 ; 61 : 26 46. 19) 松永厚美, 森 健一, 小泉文明, 他:非定型抗酸菌症に

よる感染性脊椎炎の 1 例. 西日本脊椎研究会誌. 2003 ; 29 : 104 106.

20) Phillips P, Bonner S, Gataric N, et al.: Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long term follow-up. Clin Infect Dis. 2005 ; 41 : 1483 97.

21) 伊井敏彦, 飯干宏俊, 三好かほり, 他:最近 7 年間に当 院で経験した肺非結核性抗酸菌症173例の検討. 宮崎医 学会誌. 2006 ; 30 ; 8 12.

22) McHenry MC, Duchesneau PM, Keys TF, et al.: Vertebral osteomyelitis presenting as spinal compression fracture: six patients with underlying osteoporosis. Arch Intern Med. 1998 ; 148 : 417 423.

Abstract A 77-year-old woman presented to hospital in December 2016 with back pain. She was diagnosed with thoracic compression fracture of the Th6 and Th8 vertebral bodies. She received conservative treatment, and the pain had improved. However, in September 2017, the pain worsened again, and in October 2017, paralysis of both lower limbs appeared, at which point, she was admitted to hospital again. Computed tomography (CT) revealed a tumor-like shadow around the Th6_Th8 vertebral bodies. Subsequently, she was transferred to our hospital. On admission, she was presented to the Department of Respiratory Medicine for abnormal shadows on chest CT. Chest CT revealed bronchiectasis and small nodules in the right middle and lower lobes and left lingular segment. As the sputum was not out, the patient’s gastric juice culture was analyzed; it was positive for

Myco-bacterium intracellulare. Needle biopsy samples from the areas of tumor-like shadows around the Th6_Th8 vertebral bodies were taken, and these were also positive for M.

intracellulare. Based on these fi ndings, we diagnosed the patient’s condition as vertebral osteomyelitis due to M.

intracellulare; subsequently, she received antimycobacterial therapy with rifampicin, ethambutol and clarithromycin, following which, she underwent radical debridement and

decompression surgery with anterior spinal fusion. Postop-eratively, we continued antimycobacterial therapy for 2 months, and no recurrence was detected. The rate of osteo-articular nontuberculous mycobacterial (NTM) infection has been reported to be 1_2%. Although vertebral osteomyelitis due to NTM is rare, clinicians should consider the combina-tion of nontuberculous mycobacteriosis and vertebral osteo-myelitis in cases such as the case presented herein. Key words: Nontuberculous mycobacteria, Mycobacterium

avium complex, Vertebral osteomyelitis, Paresis, Thoracic fracture

1Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; 2Department of Respiratory Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital

Correspondence to: Chie Yamamoto, Department of Pul-monary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto-shi, Kyoto 602_ 8566 Japan. (E-mail: yamamoto.chie1111@gmail.com) −−−−−−−−Case Report−−−−−−−−



1Chie YAMAMOTO, 2Haruka KUNO, 2Wataru FURUTANI, 2Isao HASEGAWA, and 2Yutaka KUBOTA


HLH Associated with TB / M. Tanigawa et al. 359

基準暫定案. 血栓止血誌. 2014 ; 25 : 629 646.

7 ) Scott RB, Rob-Smith AHT: Histiocytic medullary retic-ulosis. Lancet. 1939 ; 2 : 194 198.

8 ) Candra P, Chaudhery SA, Rosner F, et al.: Transient his-tiocytosis with striking phagocytosis of platelets, leukocyto sis, and erythrocytes. Arch Intern Med. 1975 ; 123 : 989 991. 9 ) Zhang Y, Liang G, Qin H, et al.: Tuberculosis-associated

hemophagocytic lymphohistiocytosis with initial presenta-tion of fever of unknown origin in a general hospital. Medicine. 2017 ; 96 : 1 5.

10) 熊倉俊一:血球貪食症候群の病態及び診断・治療. 島 根医学. 2016 ; 36 : 9 17.

11) Imashuku S: Differential diagnosis of hemophagocytic syndrome: underlying disorders and selection of the most effective treatment. Int J Hematol. 1997 ; 66 : 135 151. 12) Wang H, Xiong L, Tang W, et al.: A systematic review of

malignancy-associated hemophagocytic lymphohistiocytosis that needs more attentions. Oncotarget. 2017 ; 8 : 59977 59985.

13) Allen CE, Yu X, Kozinetz CA, et al.: Highly elevated ferritin levels and the diagnosis of hemophagocytic lympho-histiocytosis. Pediatr Blood Cancer. 2008 ; 50 : 1227 1235. 14) Lin F, Ferlic-Stark LL, Allen CE, et al.: Rate of decline of

ferritin in patients with hemophagocytic lymphohistiocy-tosis as a prognostic variable for mortality. Pediatr Blood Cancer. 2011 ; 56 : 154 155.

15) Asaji M, Tobino K, Murakami K, et al.: Miliary tubercu-losis in a young woman with hemophagocytic syndrome: a case report and literature review. Intern Med. 2017 ; 56 : 1591 1596.

16) 熊倉俊一:9. HPSの病態・診断・治療 Clinical feature, diagnosis and treatment of hemophagocytic syndrome. 血栓 止血誌. 2008 ; 19 : 210 215. 17) 小柳津治樹, 吉村千恵, 若山俊明, 他:結核, マイコプ ラズマ感染を契機とした血球貪食症候群の 2 例. 日呼 吸会誌. 1998 ; 36 : 787 792. 18) 藤木 玲, 白石 香, 野田和人, 他:粟粒結核に起因し た血球貪食症候群の1例. 結核. 2003 ; 78 : 443 448.

Abstract A 61-year-old man had terrible cough. He lost consciousness and displayed hypoglycemic coma and shock. He regained consciousness after receiving glucose infusion. His sputum sample tested positive for tuberculosis (TB)-PCR. Based on these results, he was diagnosed with pulmo-nary TB. He was diagnosed with hemophagocytic lympho-histiocytosis (HLH) based on the symptoms of high fever, pancytopenia, hyperferritinemia, hypofi brinogenemia and hemophagocytosis in bone marrow, and with disseminated intravascular coagulation based on the symptoms of in-creased coagulation and fi brinolysis. He was successfully treated with antituberculous drugs, steroids and anticoagu-lants. This case emphasizes the importance of early

diagno-sis and treatment for the successful treatment of HLH asso-ciated pulmonary TB.

Key words: Pulmonary tuberculosis, Hemophagocytic lym-phohistiocytosis, Disseminated intravascular coagulation, Hy-perferritinemia, Steroid

Department of Respiratory Medicine, Ise Red Cross Hospital Correspondence to: Motoaki Tanigawa, Department of Res-piratory Medicine, Ise Red Cross Hospital, 1_471_2, Funae, Ise-shi, Mie 516_8512 Japan.

(E-mail: m.tanigawa@ise.jrc.or.jp) −−−−−−−−Case Report−−−−−−−−



Motoaki TANIGAWA, Yuhei ITO, Hidetoshi ITANI, Hajime SASANO, and Hirokazu TOYOSHIMA




関連した話題 :