日本新生児成育医学会雑誌　第34巻　第2号　67 ～ 72頁（2022年）

日本新生児成育医学会雑誌　34(2)：188-193；2022　

受付日：2022．01．21

受理日：2022．05．04

経時的MRI 撮影を行った細菌性関節炎，骨髄炎の超低出生体重児の1 例

A Case of Extremely Low Birth Weight Infant Whose Course of Bacterial Arthritis and Osteomyelitis Could Be Evaluated by MRI

＊ 1 JA 尾道総合病院　小児科，＊ 2 県立広島病院　新生児科

＊ 1 Department of Pediatrics, JA Onomichi General Hospital，＊ 2 Department of Neonatology, Hiroshima Prefectural Hospital

村上　光＊ 1・藤原　信＊ 2・福原里恵＊ 2・古川　亮＊ 2・藤村清香＊ 2・佐伯久子＊ 2

Hikaru MURAKAMI ＊ 1，Shin FUJIWARA ＊ 2，Rie FUKUHARA ＊ 2，Ryo FURUKAWA ＊ 2，Sayaka FUJIMURA ＊ 2，Hisako SAEKI ＊ 2

Key Words：extremely low birth weight infant，osteomyelitis，arthritis，magnetic resonance imaging

　在胎25 週4 日，出生体重670g の女児。母体高血圧コントロール不良のため選択的帝王切開で出生し新生児集中治療室（neonatal intensive care unit：NICU）管理を行った。日齢56（修正33 週4 日）に右膝関節周辺の発赤，腫脹，右膝関節の伸展制限を認め血液検査で炎症反応の上昇を認めた。核磁気共鳴画像（magnetic resonance imaging： MRI）で右大腿骨骨髄の異常信号，膿瘍形成，関節周囲浮腫を認めたため右膝関節炎・右大腿骨髄炎と診断し抗菌薬加療，関節穿刺・吸引，発症6 日目に関節ドレナージを行い臨床所見は徐々に改善した。早産児の細菌性関節炎，骨髄炎は重篤な後遺症を残す可能性があり，早期診断・早期治療が重要である。早産児の細菌性関節炎に対して，MRI で経過を追えた症例を経験したので報告する。

The case was a girl with a gestational age of 25 weeks and 4 days and a birth weight of 670 g. Due to poor control of her maternal hypertension, she was born by selective caesarean section and was managed by NICU. On day 56, she had redness and swelling around her right knee joint, which had limited extension, and a blood test showed high inflammatory response. MRI showed an abnormal signal of the bone marrow of the right femur, abscess, and periarticular edema, so we diagnosed her as having right knee arthritis and right femoral osteomyelitis. Clinical findings gradually improved after antibiotic treatment, joint puncture・suction, and joint drainage on the 6th day after onset. Premature infants with septic arthritis and osteomyelitis may have serious sequelae, and early diagnosis and treatment are important. We report a case of bacterial arthritis in a preterm infant that was observed by MRI.