두개골 기저부 골절 후 뇌척수액 비루가 있던 환자에서 발생한 Streptococcus salivarius 수막염 1예
A Case of Streptococcus salivarius Meningitis in a Patient with Cerebrospinal Fluid Rhinorrhea after Skull Base Fracture
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초록
Streptococcus salivarius 수막염은 매우 드물며 보고된 대부분의 예는 척추 마취 또는 요추천자술과 같은 의인성에 기인한다. 외상 후 이 균에 의한 뇌수막염은 특히 드물다. 이전에 두개골 기저골절을 당한 20세 남자가 세균성 수막염 증상으로내원하였다. 뇌척수액에서 호중구가 증가되어 있었으며 그람양성구균이 관찰되었다. Vitek 미생물 자동 동정기, rapid ID32 Strep 및 16S rRNA 염기서열 분석에 의해 S. salivarius로 동정되었으며, 페니실린에 중간내성(MIC=0.25μg/mL), 세포탁심(MIC=0.25μg/mL)과 반코마이신(MIC=0.75μg/mL)에 감수성을 보였다. 환자는 세프트리악손과 반코마이신으로 치료받았으며, 내시경적 수술로 뇌척수액 누출부위가 복구되었다. 이 증례는 국내에서 S. salivarius에 의해 발생한 뇌수막염의 최초 보고로 여겨진다.
Abstract
Streptococcus salivarius meningitis is very uncommon, and most cases are iatrogenic, occurring after invasiveprocedures such as spinal anesthesia or lumbar puncture etc.. Post-traumatic occurrence of this infection is especially rare. A 20-year-old man with a previous history of skull base fracture was seen at the emergency department with signs of acute bacterial meningitis. The CSF had a few gram positive cocci with neutrophilic pleocytosis, which were identified as S. salivarius by the Vitek system (bioMerioux, Inc., Hazelwood, MO, USA), rapid ID 32 Strep (bioMerieux, Marcy-l’Etoile, France) and 16S rRNA sequencing. The microorganism showed intermediate resistance to penicillin (MIC=0.25μg/mL) but was susceptible to cefotaxime (MIC=0.25μg/mL) and vancomycin (MIC= 0.75μg/mL). The patient was treated with ceftriaxone and vancomycin. He also had his CSF leakage repaired by an endoscopic approach. To our knowledge, this is the first case of S. salivarius meningitis reported in Korea.
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