脳内出血で発症し診断が困難であった致死的ヘルペス脳髄膜炎の1例

A Case of Fatal Herpes Encephalitis Presenting Massive Cerebral Hematoma

I．はじめに

　単純ヘルペス脳炎（herpes simplex encephalitis，HSE）は壊死性脳炎とも呼ばれるように悪性の脳炎であり，早期に死に至ったり重篤な後遺症をもたらす，抗ウイルス薬であるacyclovirが治療に用いられるが，早期に投与を開始する必要があること，本剤が奏効しない症例もみられるなど，HSEは治療に苦慮する神経疾患のひとつである．

　今回われわれは，脳内出血で発症し，その後の臨床経過においてHSEの診断が困難であった症例を経験したので報告する．

A 53-year-old woman was admitted to the hospital because of headache and disturbance of conscious-ness. She was afebrile. No inflammatory reaction was identified on serologic examination. Radiologicalfindings showed acute-subacute, massive intracerebral hemorrhage in the right temporal lobe, compressingthe brain stem contra-laterally. On the clay of admission, she underwent a right temporal craniotomy forthe removal of the mass lesion. The resected brain tissue demonstrated a small hemorrhage and edemaaccompanied by the infiltration of lymphoid cells into the subarachnoid space. Several clays after surgery,the patient became lethargic and showed urinary incontinence. Late Onset of fever and CSF findings sug-gested she was suffering from viral encephalitis. Serological findings, however, disclosed no antibody pro-duction against HSV, HZV, or CMV. For the diagnosis, a biopsy of the brain was carried out and herpesencephalitis was subsequently proved. Unfortunately, her condition deteriorated quickly and she died with-out anti-viral treatment.