1992 Volume 15 Issue 2 Pages 184-189
A case of systemic lupus erythematosus (SLE) complicated with meningitis due to Enterococcus faecium is reported.
An 18-year-old female diagnosed as SLE had been treated with corticosteroid since 1988. On January 11, 1990, she was admitted to a hospital because of high fever and mental disturbance. Though she was treated with several courses of broad spectrum antibiotics and high dose of prednisolone (60 mg/day), her fever persisted and headache and neck rigidity developed. The examination of her cerebro-spinal fluid (CSF) showed pleocytosis.
She was transfered to our hospital on February 13 and the laboratory examination on admission revealed high titer of anti-nuclear antibody and anti-DNA antibody. She was diagnosed as SLE with CNS involvement and treated with steroid pulse therapy. But the pleocytosis of her CSF and her clinical symptoms did not improve. On the 8 th hospital day, Enterococcus faecium (E. faecium) was detected from the culture specimen of her CSF and in addition to steroid, antibiotics sensitive against E. faecium were administrated intravenously and intrathecally. After this combination therapy, the pleocytosis of her CSF and clinical symptoms improved gradually.
Meningitis due to E. faecium is very rare and occurs in patients receiving broad spectrum antibiotics for a long time or in patients in immunosuppressive state. In this case, it is considered that the cause of meningitis might be the disturbance of blood-brain barrier by CNS-lupus and immunosuppressive state due to steroid.
