A Case of Influenza Pneumonia Following Pneumococcal Infection in an Adult Patient with Concurrent Encephalopathy with a Lesion in the Splenium of the Corpus Callosum

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  • INOUE Yuichi
    Department of Respiratory Medicine, Isahaya Health Insurance General Hospital
  • HIRAYAMA Tatsuro
    Department of Respiratory Medicine, Isahaya Health Insurance General Hospital
  • KONDO Akira
    Department of Respiratory Medicine, Isahaya Health Insurance General Hospital
  • TOMARI Shinya
    Department of Respiratory Medicine, Isahaya Health Insurance General Hospital
  • MIYAZAKI Taiga
    Second Department of Internal Medicine, Nagasaki University Hospital
  • IZUMIKAWA Koichi
    Second Department of Internal Medicine, Nagasaki University Hospital
  • KAKEYA Hiroshi
    Second Department of Internal Medicine, Nagasaki University Hospital
  • YAMAMOTO Yoshihiro
    Second Department of Internal Medicine, Nagasaki University Hospital
  • YANAGIHARA Katsunori
    Second Department of Internal Medicine, Nagasaki University Hospital
  • TASHIRO Takayoshi
    Second Department of Internal Medicine, Nagasaki University Hospital
  • KOHNO Shigeru
    Second Department of Internal Medicine, Nagasaki University Hospital

Bibliographic Information

Other Title
  • 肺炎球菌感染を併発したインフルエンザ肺炎に，脳梁膨大部病変を伴う脳症を合併した 1 成人例
  • 症例 肺炎球菌感染を併発したインフルエンザ肺炎に,脳梁膨大部病変を伴う脳症を合併した1成人例
  • ショウレイ ハイエン キュウキン カンセン オ ヘイハツ シタ インフルエンザ ハイエン ニ,ノウリョウボウダイブ ビョウヘン オ トモナウ ノウショウ オ ガッペイ シタ 1 セイジンレイ

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Abstract

A 35-year-old male patient had a fever, cough, and other symptoms since the end of December 2010. The patient then developed a high fever and decreased SPO2, suggesting possible pneumonia. The patient was admitted to our hospital on the 6th day of illness. Chest computed tomography revealed multiple infiltrative shadows and ground-glass opacities distributed in a patchy pattern in the bilateral lungs. An atypical pneumonia was suspected, and we initiated antibiotic treatment with minocycline. However, the patient developed consciousness disturbance in the afternoon of the 7th day of illness. The high fever persisted, suggesting the patientʼs poor response to minocycline treatment, which was then replaced with ciprofloxacin and imipenem/cilastatin on the 8th day of illness. Streptococcuspneumoniae was detected in the blood culture bottles submitted at the time of admission. A head magnetic resonance imaging performed on that day showed a high intensity area in the splenium of the corpus callosum, leading to a diagnosis of encephalopathy. Methylprednisolone pulse therapy and gamma globulin treatment were initiated. The patient then recovered consciousness gradually with improvement of inflammatory responses and imaging findings. Subsequently, an influenza virus (H1N1) antibody level was found to have increased from less than 10 times to 640 times. Thus, it was determined that the patientʼs pneumonia and encephalopathy were attributable to the influenza A (H1N1) pdm09 virus during the flu season and Streptcoccal infection. Combination therapy, such as steroid pulse treatment, appropriate antibiotics and gamma globulin preparation was effective for both the flu-induced mixed pneumonia and encephalopathy in this patient.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 87 (4), 451-456, 2013

    The Japanese Association for Infectious Diseases

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