Hattori S, Isogai Y, Morimoto Y
Third Department of Internal Medicine, Jikei University School of Medicine.
Rinsho Shinkeigaku. 1993 Jun;33(6):642-5.
A 47-year-old man suffered from a headache, fever and memory disturbance. He was admitted to Morimoto Hospital. Neurological examination revealed disturbance of memory of recent events. Cranial nerves were normal. Muscle strength of the extremities was normal, except for Barré's sign of the right upper extremity. Deep tendon reflexes were exaggerated bilaterally, and extensor plantar response of the left side was elicited. Sensory examination showed no abnormality. Cerebellar sign was not recognized. Meningeal sign was slightly but clearly showed. CT scan demonstrated brain swelling at the right insular cortex region followed by severe hydrocephalus with dilatation of the lateral and the third ventricles. Cerebrospinal fluid showed high CSF pressure (250 mmH2O), pleocytosis (C.C. 359/mm3) and elevated protein level (213 mg/dl). Virological examination revealed herpes simplex virus (HSV) (CF) 32x, HSV-1 IgG (EIA) 4,050X, rubella virus IgE (EIA) 6,060X, cytomegalovirus (CMV) IgG (EIA) 1,130X in serum and HSV (CF) 1X, HSV-1 IGg (EIA) 1,430X, rubella virus IgG (EIA) 1,480X, CMV IgG (EIA) 587X in CSF. The ratio of serum/CSF of HSV and rubella virus titers by EIA methods were 2.83 and 4.10, respectively. He was treated by acyclovir 1,000 mg/day and gamma globulin, but his condition get worse acutely and died at 15th hospital days. This case was considered as a meningoencephalitis caused by simultaneous HSV and rubella virus infection.
一名47岁男性出现头痛、发热及记忆障碍。他被收治入森本医院。神经系统检查发现近期事件记忆障碍。颅神经正常。四肢肌力正常，但右侧上肢有巴宾斯基征。双侧腱反射亢进，引出左侧跖伸反应。感觉检查无异常。未发现小脑征。脑膜征轻微但明显阳性。CT扫描显示右侧岛叶皮质区脑肿胀，随后出现严重脑积水，侧脑室和第三脑室扩张。脑脊液显示脑脊液压力升高（250mmH₂O）、细胞增多（细胞计数359/mm³）及蛋白水平升高（213mg/dl）。病毒学检查显示血清中单纯疱疹病毒（HSV）（补体结合试验）32倍、HSV-1 IgG（酶免疫测定）4050倍、风疹病毒IgE（酶免疫测定）6060倍、巨细胞病毒（CMV）IgG（酶免疫测定）1130倍，脑脊液中HSV（补体结合试验）1倍、HSV-1 IgG（酶免疫测定）1430倍、风疹病毒IgG（酶免疫测定）1480倍、CMV IgG（酶免疫测定）587倍。采用酶免疫测定法检测，HSV和风疹病毒血清/脑脊液滴度比值分别为2.83和4.10。给予阿昔洛韦1000mg/天及丙种球蛋白治疗，但他的病情急剧恶化，于住院第15天死亡。该病例被认为是由HSV和风疹病毒同时感染引起的脑膜脑炎。
