<i>Streptococcus pneumoniae</i>による細菌性髄膜炎を生じた蝶形骨洞炎例

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  • A Case of Pneumococcal Meningitis Caused by Sphenoid Sinusitis
  • Streptococcus pneumoniaeによる細菌性髄膜炎を生じた蝶形骨洞炎例
  • Streptococcus pneumoniae ニ ヨル サイキンセイ ズイマクエン オ ショウジタ チョウケイコツドウエンレイ

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<p>The incidence of intracranial complications caused by sinusitis is decreased by the development of the antibiotics. However, fatal complications are still occasionally reported. We report a case of pneumococcal meningitis caused by sphenoid sinusitis.</p><p>A 32-year-old woman, who has been nursing five-month-child, had a common cold in the middle of January 2014. She has been recognized in a clinic because of a headache in February. She had no fever, and was nursing, so only a painkiller was prescribed. However, she had a high fever and vomiting on the next day, and became loss of consciousness in the midnight, and then was taken by ambulance to our hospital.</p><p>The state of consciousness was Glasgow Coma Scale (GCS) E3V1-2M4. She had a stiff neck, and Kernig’s sign was positive. Cerebrospinal fluid examination revealed that cell count was 4736/3, and sugar was 20 mg/dL and that Streptococcus pneumoniae antigen was positive. Computed tomography (CT) images showed pneumocephalos in the brain and soft tissue density in the left sphenoid sinus. We diagnosed as bacterial meningitis caused by the sphenoid sinusitis, and endoscopic sinus surgery (ESS) was performed in emergency.</p><p>The left sphenoid sinus was filled with pus, and so we removed it and washed enough. We could not find cerebrospinal fluid leakage nor bone defect in the sphenoid sinus. S. pneumoniae was cultured from the pus. We continued the antibiotic administration and the nasal irrigation after the operation. She recovered consciousness on the next day after the operation, and the blood test returned to normal on the eighth day. She was discharged without complications on the twenty-first day.</p><p>We experienced a case of pneumococcal meningitis caused by sphenoid sinusitis, which was caused by hesitation of antibiotics administration for the nursing. Pneumococcal meningitis has a high fatality rate, and the rate of complications was reported to be 30%. The patient was successfully treated without complications by ESS and antibiotic administration.</p>

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