難治性潰瘍性大腸炎に合併したステロイド性骨壊死症の一例

We report a case of steroid-induced osteonecrosis in a patient with refractory ulcerative colitis. A 31 year-old woman presented suffering from refractory ulcerative colitis. She had been treated by prednisolone for ten years. Sharp pain and swelling appeared suddenly in her right knee. Conventional radiography revealed neither osteoporosis nor a fracture. However, magnetic resonance imaging by T1-, T2- and T2*-weighted images revealed irregular heterogeneous areas of low- and high-intensity in her right femur and tibia. For a precise early diagnosis of osteonecrosis, bone magnetic resonance imaging was found to be an excellent diagnostic tool.
難治性潰瘍性大腸炎に合併したステロイド性骨壊死症の一例を報告した.患者は,31歳女性.難治性潰瘍性大腸炎に対して10年前よりプレドニゾロン投与を受けており精査加療目的にて当科入院となった.入院加療中,突然,右膝の痺痛・腫脹が出現.単純X線写真では,同部に骨粗籟症も骨折像も指摘できなかったが,核磁気共鳴画像(MRI)T1,T2・強調像にて右大腿骨・脛骨に低,高信号が混在する不均一な不整形領域を認めステロイド性骨壊死と診断し得た.ステロイド性骨壊死の正確な早期診断には,MRIが極めて有用である.