[A case of ventriculitis with bacterial meningitis occurred during the treatment of liver abscess].
A 47-case-year old male was admitted to our hospital because of high fever and general fatigue. He had no immune deficiency, and had no other disease in his past history. On admission, the white blood cell count and C-reacted protein were severely elevated (18,700/microliter, 27.7 mg/dl, respectively) and abdominal CT revealed multiple low density, From these results, he was diagnosed as liver abscess. Intravenous MINO and SBT/CPZ injection were started. On the fifth hospital day, he suffered from headache and nuchal rigidity. The clinical data revealed the cerebro-spinal fluid (CSF) counting 8,336 cells/mm3 (mononuclear 8,000,) protein at 119 mg/dl, and sugar 42 mg/dl. CSF cultures were negative, but Klebsiella was recognized in the blood culture and drainage fluid in liver abscess. This condition was diagnosed as bacterial meningitis and antibiotics were changed to intravenous CTRX and MEPM. Furthermore we administered oral PSL and intravenous steroid-pulse therapy. After these combination therapies his condition improved gradually. After 40 hospital day, however, he suddenly had double vision, Axial FLAIR (SE6,000/120) image revealed with high signal intensity at 4th ventricle. Intravenous MEPM was administered again. On the 60th hospital day, double vision was gradually improved and abnormal intensity at 4th ventricle was almost disappeared. This case may provide us a considerable suggestion on the treatment of bacterial meningitis.
Honma
Yuko
Y
Division of Neurology, St. Marianna University School of Medicine.
Shiraishi
Makoto
M
Yanagisawa
Toshiyuki
T
Maki
Futaba
F
Sugihara
Hiroshi
H
Takahashi
Yoichi
Y
Otsuka
Yuka
Y
D002552:Cerebral Ventricles; D004660:Encephalitis / Q000150:complications*; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications; D007711:Klebsiella pneumoniae; D008100:Liver Abscess / Q000150:complications* / Q000188:drug therapy; D016920:Meningitis, Bacterial / Q000150:complications*; D008875:Middle Aged