脊髄硬膜外膿瘍・腸腰筋膿瘍を合併した咽後膿瘍の1症例

抄録

Our case is a 71-year-old man with a history of diabetic renal failure who began hemodialysis treatment 5 years earlier. He visited an orthopedic surgeon 2 days before visiting our facility, and his condition was conservatively treated as cervical spondylolisthesis. After that, a disorientation disorder developed, and a computed tomography (CT) scan indicated an abscess on the left side of the posterior wall of the oropharynx. Only diffuse mild bulging was observed on the left side of the posterior wall of the oropharynx and no other abnormality was observed in the oral cavity and throat. A CT examination confirmed a complication in the spinal epidural abscess. A cerebrospinal fluid examination was performed, and bacterial meningitis was diagnosed. Blood glucose control and antibiotic drug administration were performed. However, because of the persistence of fever and poor improvement observed by CT and cerebrospinal fluid examinations, incisional drainage and tracheostomy were performed for the retropharyngeal abscess on the 12th day after admission. Because lower limb muscle weakness and low back pain remained and because a lumbar disc lesion and psoas abscess were recognized by magnetic resonance imaging, drainage was placed in the psoas abscess on the 17th day. The retropharyngeal abscess rapidly disappeared, and after treatment by orthopedic surgery, he was transferred for the purpose of rehabilitation on the 148th day.

The cause in this case was thought to be purulent spondylitis developing in the posterior portion of the throat and the psoas muscle, forming an abscess. In the case of retropharyngeal abscesses in elderly patients with impaired immune ability, it seems necessary to conduct a thorough examination and choose a treatment that will effectively control the inflammation from spreading to other sites.