糖尿病及乾癬病人併發化膿性薦腸骨關節炎及骨盤膿瘍在使用顯影劑加強後其核磁共振造影之特徵

Pyogenic Sacroiliitis Complicated with Pelvic Abscess in a Diabetic Patient with Psoriasis: Assessment with Gadolinium-enhanced Magnetic Imaging

化膿性薦腸骨關節炎在臨床上難於診斷。主要因症狀不明顯，且傳統放射線表徵常在晚期出現。本文提出一位53歲女性病人最近十天因發燒，左臀部劇痛並放射至左臀部上側，並無法行動。過去有十年乾癬病史，且有八年糖尿病史，並接受每天10mg Euglucon治療，血糖控制在180mg至250mg/dl之間。理學檢查發現左臀部有局部劇痛，且左臀部上側有痛覺過度敏感。在頭皮、四肢、軀幹、臀部及下肢發現乾癬病灶。在血液及左下肢皮膚病灶培養出Group B鏈球菌。以Gadolinium顯影劑加強後其核磁共振造影發現左側薦腸骨關節病灶在遲退時間T2，病灶信號的自旋回波波序增強，提示左側薦腸骨節內有滲液，骨水腫，及關節周圍有發炎現象。在遲退時間T1病灶信號的自旋回波波序均變弱。但在使用對比劑後之遲退時間T1，在左側薦腸骨關節前病灶信號的自旋回波波序卻有圜狀增強現象，此核磁共振造影表現提示該病灶為一膿瘍。經靜脈注射Prostaphyllin每天8gm共四週，再追加Norfloxacin每天600mg口服共二週後，病人可以自由活動。

Pyogenic sacroiliitis is often difficult to diagnose because the clinical findings can be misleading and the radiological signs delayed. This report describes the use of gadopentetate dimeglumine (Gd-DTPA) enhanced magnetic resonance imaging (MRI) in the diagnosis of this disease. A 53-year-old woman presented with a 10-day history of fever, left buttock pain radiating to left superior gluteal region, and inability to walk. She had a 10-year history of psoriasis vulgaris and an 8-year history of diabetes mellitus. On examination, there was extreme tenderness in the left buttock area. Psoriatic skin lesions were found in the scalp, trunk, buttocks, and extremties. Group B streptococci were isolated from blood and psoriatic lesions in the left leg. MRI of the pelvis with Gd-DTPA enhancement showed sacroiliac (SI) joint effusion, bone edma, and adjacent inflammation as high signal on T2-weighted spin echo (SE) scans, and identified an abscess as a rim-enhancing lesion anterior to the SI joint on gadolinium-enhanced T1-weighted SE scans. The patient was treated with piperacillin 8 g/day intravenously for 4 weeks followed by Norfloxacin 600 mg/day orally for 2 weeks. After this, she was able to perform daily activities without back pain. We suggest that Gd-DTPA-enhanced MRI can provide a sensitive diagnostic tool in patients with pyogenic sacroiliitis.