慢性中耳炎併發腦膜炎致死

在抗生素尚未發明前，中耳炎一直是顱內感染之主要來源。而在抗生素發展迅速及廣被使用後，耳源性顱內感染則較為少見。一般耳源性的顱內感染，多發生於15歲以前的幼童及成人中耳炎併發膽脂瘤之病患，單純成人慢性化膿性中耳炎所併發之腦膜炎誠屬不多見，而以A族鏈球菌為感染源的病例，更屬少見。本病例為－50歲男性病患，左耳罹患膿樣分泌物已有數月之久，未曾接受常規治療。於到院當日前3日開始，出現身體不適和發燒等症狀，最後因意識不清及躁動不安而被送至本院。由於病患出現頸部僵直等神經學症狀，在高度疑似腦膜炎的臆測下，實施腰椎穿刺。而後在細菌學培養下，證實腦脊髓液與耳漏膿液同為A族鏈球菌感染，故確立慢性化膿性中耳炎併發腦膜炎之診斷。入院後，病人接受抗生素等藥物之保守性治療，並未施予根除乳突竇切除手術，之後由於菌血症併發多重器官衰竭而死亡。近年來，由於耳源性腦膜炎之發生已屬少見，是以特提出此一病例報告。

關鍵字

慢性中耳炎；腦膜炎； A族鏈球菌

並列摘要

Before the advent of antibiotics, otitis media was one of the leading causes of intracranial infection. Otogenic intracranial infection was typically seen in children younger than 15-years of age and in adults with otitis media and a cholesteatoma. Chronic otitis media complicated by meningitis in the absence of a cholesteatoma in adults was less frequently seen. After the rapid development and wide use of antibiotics, otogenic intracranial infection became a clinical rarity. Although group-A streptococcus is usually the infectious agent, it is only infrequently isolated. A 50-year-old man presented with a purulent discharge from his left ear that had been present for several months but for which no regular treatment had been sought. He was sent to hospital because of his altered sensorium and irritability, which followed the development of general malaise and fever. Neck stiffness was found on physical examination and meningitis was suspected. A lumbar puncture was performed and group-A streptococcus was isolated from both cerebrospinal fluid cultures and the purulent left ear discharge, confirming the suspected diagnosis of chronic otitis media complicated by meningitis. The patient was admitted and received antibiotic treatment, but a radical mastoidectomy was not performed. The patient died of septicemia and subsequent multiple organ failure. This case serves as a reminder of the sometimes serious complications of untreated otitis media.

並列關鍵字

chronic otitis media ； meningitis ； group-A streptococcus

國際替代計量

慢性中耳炎併發腦膜炎致死

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