抗生物質，とくに炎症反応の軽快に塩酸ミノサイクリンが有効であった肥厚性硬膜炎の1例

A Case of Hypertrophic Pachymeningitis Treated Successfully with Antibiotics: The Remarkable Effect of Minocycline Hydrochloride in Reducing the Serum C-reactive Protein Value

Ⅰ．はじめに

　眼球結膜の充血を主訴とし，抗生物質，特に塩酸ミノサイクリンの静脈内投与が有効であったと思われる肥厚性硬膜炎の1例を経験したので報告する．

　A 70-year-old man had hyperemia of the right cornea associated with a high serum C-reactive protein value.

　MRI of the head revealed hypertrophic pachymeningitis associated with a mass in the right cavernous sinus. The hypertrophic dura showed iso-intensity on T1-weighted image, and very low intensity on T2-weighted image, and was markedly enhanced with gadolinium. In contrast, the mass in the right cavernous sinus was only slightly enhanced.

　Intravenous administration of some antibiotics (piperacillin sodium, ampicillin sodium/ sulbactam sodium, ampicillin sodium, cefozopran hydrochloride) was begun, but minocycline hydrochloride, which was subsequently administrated, proved remarkably effective in relieving symptoms and decreasing the serum C-reactive protein value, although other antibiotics showed little or no effect.

　MRI performed 9 days after initiation of minocycline therapy showed remarkable relief from hypertrophy of the dura compared with a scan obtained before admission.

　Although hypertrophic pachymeningitis in this case may have been associated with infection by bacteria that were especially sensitive to minocycline, the drug is believed to have anti-inflammatory and immunosuppressive effects similar to those of steroids used to relieve the symptoms of rheumatoid arthritis or Takayasu arteritis.

　We suspect that hypertrophic pachymeningitis in this patient may have been idiopathic or associated with an autoimmune disease, and may therefore have been relieved by the anti-inflammatory and immunosuppressive effects of minocycline in a manner similar to the effect of steroids on similar types of hypertrophic pachymeningitis.