治療経過中に髄膜脳炎を併発したツツガムシ病

・ツツガムシ病のミノサイクリンによる治療経過中に髄膜脳炎を併発した1例を経験した．

・治療開始から4日後に突然の意識障害をきたし，髄液検査で髄膜脳炎が疑われた．

・ツツガムシ病に伴う髄膜炎や髄膜脳炎にミノサイクリン治療が奏効した例は報告があるが，治療開始後に意識障害を認め，同治療継続により改善を認めたことを示した報告はまれである．

（「症例のポイント」より）

　

A case report of scrub typhus complicated with meningoencephalitis under treatment

　

Endo, Ruriko1）Ishizuki, Shoichiro1）Taguchi, Shijima2）Shioya, Ayako3）Ishioka, Haruhiko4） 1）Department of Dermatology, University of Tsukuba Hospital 2）Department of Dermatology, Mito Kyodo General Hospital 3）Department of Neurology, Mito Kyodo General Hospital 4）Department of Infectious diseases, Mito Kyodo General Hospital

　

We report a case with scrub typhus complicated with meningoencephalitis. A 61-year-old man with a tick bite developed fever and black eschar. The blood test revealed a multiorgan failure and atypical lymphocytes. He was clinically diagnosed with scrub typhus. Soon after starting treatment with minocycline, he became stupor. Although brain MRI showed no notable change, the cerebrospinal fluid revealed encephalitis with mild pleocytosis with monocyte domination and mildly high protein level. We continued minocycline treatment as we diagnosed with encephalitis caused by scrub typhus. Finally, he recovered without any complication.