脳膿瘍で発症した播種型ノカルジア症の1例

Disseminated Nocardiosis Complicated by Multiple Brain Abscesses:A Case Report

Ⅰ．はじめに

　ノカルジアは放線菌目ノカルジア科ノカルジア属に分類される好気性グラム陽性桿菌で，広く土壌中に生息する好気性の微生物である²⁾．近年，日和見感染症として罹患率が上昇している^7,16)．ノカルジア感染症の病型は，肺型，皮膚型，播種型に分類され⁹⁾，播種型ノカルジア症は肺病変を伴うことがほとんどで死亡率も高いため，死亡率の低減には早期の確定診断と治療が重要である¹⁵⁾．今回，肺病変を伴わない播種型ノカルジア症を経験して根治し得たので報告する．

　We report a relatively rare case of a disseminated type of nocardiosis without lung involvement. A 75-year-old man developed moderate fever and disturbed consciousness and was admitted to our hospital. Laboratory examinations revealed signs of inflammation. Chest X-rays indicated no abnormalities, but brain MRI showed ring-like enhancement lesions in the right temporal and left frontal lobes. Similar lesions were identified in the left kidney and right leg. The brain lesions were purulent and were surgically irrigated. Gram- and Kinyoun-positive bacteria were identified, and the patient was diagnosed as suffering from a disseminated type of nocardiosis without lung involvement. He was treated with trimethoprim-sulfamethoxazole for over 10 months. The postoperative course was uneventful, and he was discharged without any neurological sequelae two months after surgery. Kinyoun staining was important in early diagnosis and hence providing appropriate therapy for life-threatening nocardiosis.