Damergis Jennifer A, Chee Kerlen, Amitai Allon
Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
J Emerg Med. 2010 Sep;39(3):e109-12. doi: 10.1016/j.jemermed.2007.10.082. Epub 2008 Jul 2.
Streptococcus pneumoniae accounts for approximately 50% of bacterial meningitis cases in the United States annually. Since the advent of antibiotics, pneumococcal meningitis as a complication of a primary otogenic focus has been rare in the United States. The widespread use of immunosuppressants and increasing bacterial resistance to commonly prescribed antibiotics may contribute to a higher incidence of complications of otitis media in the future, similar to that of the pre-antibiotic era. We report a case of otogenic pneumococcal meningitis with pneumocephalus in an adult male on chronic immunosuppressant therapy. A 33-year-old man with Crohn's disease and azathioprine use presented to our Emergency Department with progressive headache while taking antibiotics for otitis media. Initial computed tomography scan of the brain revealed pneumocephaly, and cerebrospinal fluid analysis and culture diagnosed pneumococcal meningitis. The patient continued to have fevers while receiving intravenous antibiotics and underwent bilateral myringotomies; his clinical course subsequently improved significantly. Meningitis is a rare complication of Streptococcus pneumoniae infections since the advent of antibiotics; however, it may become more frequent with increasing antibiotic resistance and a growing population of immunocompromised patients. Additionally, pneumocephalus in the setting of meningitis and otitis media should raise the suspicion for mastoiditis (even without overt clinical findings) and early consultation with an otolaryngologist is warranted.
在美国，肺炎链球菌每年约占细菌性脑膜炎病例的50%。自抗生素问世以来，作为原发性耳源性病灶并发症的肺炎球菌性脑膜炎在美国已较为罕见。免疫抑制剂的广泛使用以及细菌对常用抗生素耐药性的增加，可能导致未来中耳炎并发症的发生率升高，类似于抗生素使用前的时代。我们报告一例在接受慢性免疫抑制治疗的成年男性中发生的耳源性肺炎球菌性脑膜炎合并气颅病例。一名患有克罗恩病且正在使用硫唑嘌呤的33岁男性，在因中耳炎服用抗生素期间因进行性头痛前来我院急诊科就诊。最初的脑部计算机断层扫描显示有气颅，脑脊液分析和培养诊断为肺炎球菌性脑膜炎。患者在接受静脉抗生素治疗期间持续发热，并接受了双侧鼓膜切开术；其临床病程随后显著改善。自抗生素问世以来，脑膜炎是肺炎链球菌感染的一种罕见并发症；然而，随着抗生素耐药性的增加和免疫功能低下患者群体的扩大，这种情况可能会变得更加频繁。此外，在脑膜炎和中耳炎背景下出现气颅应引起对乳突炎的怀疑（即使没有明显的临床症状），有必要尽早咨询耳鼻喉科医生。
