クモ膜下出血および硬膜下血腫を呈したpeptostreptococcusによる髄膜炎の1例

A CASE OF PEPTOSTREPTOCOCCAL MENINGITIS ASSOCIATED WITH SUBARACHNOID HEMORRHAGE AND SUBDURAL HEMATOMA

　抄録　無芽胞嫌気性菌であるpeptostreptococcusによる髄膜炎の経過中にクモ膜下出血および硬膜下血腫を同時期に呈した1例を経験した。髄膜炎の合併症としてクモ膜下出血，硬膜下血腫の報告はあるが，両者を合併した報告はない。脳血管撮影では，出血源を示唆する所見は得られなかったが，髄膜の炎症が脳表の微細血管に波及して局所的血管炎をきたし，脳血管撮影上同定不能な細菌性脳動脈瘤を形成し，これが破裂したためにクモ膜下腔と硬膜下腔に同時に出血をきたしたと推定した。またpeptostreptococcusによる髄膜炎は稀であり，本症例のごとく何ら基礎疾患のない健康成人において発症したことより，今後髄膜炎の起炎菌として考慮しておく必要がある。

A very rare case of peptostreptococcal meningi-tis associated with subarachnoid hemorrhage and subdural hematoma was reported.

A 25-year-old man was admitted to St. Mary's Hospital on November 6, 1984 with a few day's history of headache and low grade fever.

On admission, he had high grade fever (39. 2°C) and tachcardia (110/min). There were no neurolo-gical deficits other than neck stiffness and Ker-nig's sign. The cerebrospinal fluid (CSF) which was obtained through lumbar puncture showed wateryclear appearance, white cell count of 32/3 mm³ (mononuclear : polymorphonuclear =4 : 5), protein 76 mg/dl and glucose 8 mg/dl. It was found to be sterile. However, peptostreptococcus was found in his peripheral blood culture. He was diagnosed peptostreptococcal meningitis.

After administration of antibiotics, laboratory test result of CSF improved gradually so as his meningeal irritation signs.

After 25 days of hospitalization, he developed suddenly severe headache. CSF showed bloody and xanthochromic appearance, and CT scan revealed a subdural hematoma in the left fronto-temporal convexity.

Although we suspected formation of mycotic aneurysm caused by the meningitis and its rupture, cerebral angiography revealed no abnormality except for the findings of subdural hematoma. The subdural hematoma was completely absor-bed and he was discharged 79 days after admis-sion without having any neurological deficit.

We concluded that such a mycotic aneurysm was too small to be detected by the cerebral angiography.