特異なる経過を示した耳性髄膜炎の1例

A RARE CASE OF SEVERE OTOGENIC MENINGITIS COMPLETELY CURED

　I．緒言

　抗生物質治療の著しい進歩は，耳性頭蓋内合併症の予防および治療に決定的な影響を与え，現在非常に稀なものとなつてきた。しかしその反面抗生剤の日常頻ぱんな投与により耐性菌の出現や，グラム陰性桿菌感染が問題となつてきている。また抗生剤の乱用により本来の症状がmaskingされた非定型的疾患が多く報告されている。そうした事実は症状を複雑化する一方，早期に確定診断困難な症例を増加させることとなる。われわれは最近，強度の意識混濁を認め，生存が危ぶまれたが，耳性髄膜炎との診断下に手術を施行するとともに，抗生剤，ステロイド剤などの投与により当初心配された神経学的後遺症もまつたくなく，著明なる改善を認めた症例を経験したのでその詳細を報告する。

　Since the employment of antibiotics in clinical us has made a tremendous stride forward recently, cases of cerebral complications among car diseases have been surprisingly decreased. But on the other hand, because of this use the existing symptoms may be subdued or concealed. We report a case in point of this nature.

　The patient, a policeman aged 48, with a historyof diabetes mellitus, complained of a long-standing slight pain and discharge of the right ear. Administration of antibiotics and steroids was continued for a week when the patient no longer made his appearance at the clinic.

　Two weeks later the patient was overcome by a loss of consciousness when he was taken to an emergency hospital where the diagnosis of cerebro-spinal involvement was made. Five days later the patient was referred back to us.

　The patient was semicomatous with symptoms of acute pneumonia. From our previous experience, the diagnosis of aural-cerebro-spinal meningitis was made. The patient was operated upon; diabetic control was established. and with the use of antibiotics, the patient made a complete recovery within the period of 2 months after the second admission, when he was returned to his old job.