Chronic Pyelonephritis may Cause Fungal Spondylodiscitis with Abscess: Two Rare Case Reports

慢性腎盂腎炎可能導致真菌性脊椎間盤炎合併膿瘍：兩個罕見病例報告

古哲維(Che-Wei Ku) ； 姜秉均(Bing-Juin Chiang) ； 廖俊厚(Chun-Hou Liao)

《輔仁醫學期刊》 18卷1期 (2020/03) Pp. 31-37

https://doi.org/10.3966/181020932020031801004

摘要

Spondylodiscitis is an inflammatory disease characterized by primary infection of the intervertebral disc and/or secondary infection to the adjacent vertebrae. Fungal etiology is rare. Fungal spondylodiscitis is a rare spinal infection and usually develops in immunocompromised patients, especially in those with a malignant tumor, chronic urogenital tract infections, diabetes, or advanced age or in those taking immunosuppressive drugs for organ transplantations. Chronic pyelonephritis is a complication of repeated bouts of acute pyelonephritis. In the present report, two patients diagnosed with chronic pyelonephritis were treated with antibiotics for more than six months. They presented with symptoms of sudden-onset low back pain and fever. Magnetic resonance imaging revealed fungal spondylodiscitis with abscess, which was confirmed with surgery and culture. Fungal spondylodiscitis may result from chronic pyelonephritis. The patients received intravenous antifungal agents after spinal surgery, followed by oral antifungal agents. Their symptoms improved with treatment, and they were discharged after surgery.

關鍵字

spondylodiscitis ； chronic pyelonephritis ； fungal spondylodiscitis ； magnetic resonance imaging

並列摘要

脊椎間盤炎是一種椎間盤感染合併或不合併周邊及椎骨感染的發炎疾病。由真菌造成的感染是罕見的。真菌性脊椎間盤炎是罕見的，尤其通常出現在惡性腫瘤、慢性生殖泌尿道感染、糖尿病、年長者或使用免疫抑制劑的器官移植等免疫抑制的病人。而慢性腎盂腎炎是一種反覆急性腎盂腎炎的併發症。我們提出兩個慢性腎盂腎炎合併出現下背痛及發燒的病人，經由脊椎核磁共振檢查及尿液和手術檢體的真菌培養確診為真菌性脊椎間盤炎合併膿瘍。治療包括靜脈注射抗真菌劑和脊椎手術。病人在治療後順利出院。

並列關鍵字

脊椎間盤炎 ； 慢性腎盂腎炎 ； 真菌性脊椎間盤炎 ； 核磁共振