両視神経周囲炎の治療経過中に致死性の髄膜炎を生じた1例

A case of fatal meningitis during the course of treatment for bilateral peripapillary neuritis

要約　目的：両視神経周囲炎に対するステロイドパルス療法中に致死性の髄膜炎を生じた1例の報告。

症例：74歳，男性。既往に急性骨髄性白血病および急性心筋梗塞があった。1か月前からの急激な両眼視力低下を認め，当科を紹介され受診した。

結果：両眼特発性視神経炎と診断し，ステロイドパルス療法施行後に再発を認め，合計4コース施行した。再発時，上記既往以外にB型肝炎既感染および潜在性肺結核症があることが判明していた。ステロイドパルス療法4コース目終了から算定して第4病日より全身状態が急変した。結核性髄膜炎または細菌性髄膜炎を疑い，抗菌薬治療を開始するも第6病日に死亡した。

結論：ステロイドパルス療法はきわめて有用な治療法であるが，施行回数が増すほど致死的なものを含む合併症の危険性が高まるため，適応を慎重に判断し，施行する際は早急に他科と連携できるような準備を整えるべきである。

Abstract　Purpose：We report a case of fatal meningitis occurring during steroid pulse therapy for bilateral peripapillary neuritis.

Case：A 74-year-old man who experienced acute visual loss in both eyes over the past month. The patient had a history of acute myelogenous leukemia and acute myocardial infarction.

Results：A diagnosis of idiopathic optic neuritis in both eyes was established, and steroid pulse therapy was administered. After treatment completion, the patient relapsed, and an additional course of steroids was administered until a total of four courses of steroid pulse therapies were completed. At the time of recurrence, co-infection of hepatitis B and latent pulmonary tuberculosis were established. His general condition suddenly changed on the 6th day after terminating the 4th course of steroid pulse therapy. Suspecting tuberculous meningitis or bacterial meningitis, antimicrobial therapy was initiated. However, the patient died on the 6th day.

Conclusion：Steroid pulse therapy is an extremely useful treatment method, but the risk of complications as a result of a compromised immune system, including fatal ones, increases with the frequency of use. Patients should be carefully evaluated for indications for pulse therapy and preparation for immediate collaborations with other departments should be anticipated.