髄膜炎と副鼻腔炎に合併した両眼窩筋円錐内膿瘍の1例

A case of bilateral intraconal orbital abscess with meningitis and sinusitis

要約　目的：細菌性髄膜炎と副鼻腔に続発した両眼の眼窩筋円錐内膿瘍の1症例の報告。症例：52歳男性が意識不明の状態で発見された。その3日前から体調が不良であった。細菌性髄膜炎，播種性血管内凝固症，両篩骨洞炎，両蝶形骨洞炎があった。両側の眼窩内に複数の腫瘤があり，眼窩筋円錐内の腫瘤が視神経を圧迫し，網膜皺襞と眼球運動障害があった。眼窩内の病変は抗菌薬には反応せず，手術による排膿で治癒した。Streptococcus milleri groupが検出され，膿瘍と診断された。結論：篩骨洞炎と蝶形骨洞炎から細菌感染が血行性に進展し，髄膜炎と両側の眼窩筋円錐内腫瘍が生じたものと考えられる。抗菌薬投与が無効であったのは，眼窩内膿瘍が被膜に覆われていたためと推定される。

Abstract.　Purpose：To report a case bilateral intraconal orbital abscess with meningitis and paranasal sinusitis. Case and Findings：A 52-year-old male was found in unconscious state. He had been unwell since 3 days before. He was diagnosed with bacterial meningitis, disseminated intravascular coagulopathy, and bilateral ethmoidal and sphenoidal sinusitis. Both eyes showed multiple tumors in the orbit. Masses of intraconal tumor compressed both optic nerves resulting in retinal folds and impaired ocular motility. The orbital lesion failed to respond to systemic antibiotics and was cured by surgical drainage. Streptococcus milleri group was cultured from the abscess. Conclusion：Meningitis and bilateral intraconal abscess appeared to be secondary to ethmoidal and sphenoidal sinusitis by spread of bacterial organism through blood vessels. The orbital abscess failed to respond to antibiotics as it was covered by a taut coating.