急性のホットフット。シャルコー神経関節症か骨髄炎か？診断の網を解く

Acute hot foot: Charcot neuroarthropathy or osteomyelitis? Untangling a diagnostic web.

• Louise Goldsmith
• Matthew Barlow
• Paul Jeffrey Evans
• Upendram Srinivas-Shankar

抄録

1型糖尿病のコントロール不良で，微小血管と大血管の合併症を有する55歳の男性が，1週間前から左足背側に有痛性の紅斑性腫脹を認め，2部位に足底潰瘍を認めた．炎症性マーカーが上昇していた。左足のMRIでは，左足背側の軟部組織腫脹，骨髄浮腫，足のいくつかの小関節の破壊が認められ，骨髄炎とCharcot neuroarthropathy（CN）を示唆していた．左足背側の軟部組織腫脹を切除し、第5中足骨基部の骨破壊を認めた。術後6週間の抗生物質の静脈内投与を行った。左足の紅斑、水腫、体温上昇を含むCNの臨床的特徴は、6ヶ月後にエアギプス歩行器で足の負担を軽減することで治まった。我々の症例は、神経障害を持つ糖尿病患者の急性炎症足において、軟部組織感染症や骨髄炎などの他の疾患が臨床的特徴を説明できる場合であっても、CNを認識する必要性を強調している。

A 55-year-old man with poorly controlled type 1 diabetes with microvascular and macrovascular complications presented with a 1-week history of painful erythematous swelling on the dorsum of the left foot with two areas of foot ulceration. Inflammatory markers were raised. MRI of the left foot revealed a soft tissue swelling on the dorsum of the left foot, marrow oedema and destruction of several small joints of the foot, indicating osteomyelitis and Charcot neuroarthropathy (CN). The soft tissue swelling on the dorsum of the left foot was debrided; per-operatively bone destruction of base of the fifth metatarsal was found. The patient received intravenous antibiotics for 6 weeks. The clinical features of CN including erythema, oedema and elevated temperature of the left foot settled with off-loading the foot in an air cast walker after 6 months. Our case highlights the need to recognise CN in an acutely inflamed foot of diabetic patients with neuropathy, even when other conditions like soft tissue infection and osteomyelitis can explain the clinical features.

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