Abstract
A 63-year-old male was admitted to Kushiro Rosai Hospital because of sudden onset of headache, nausea and vomiting. Pysical examination revealed disturbance of consciousness, nuchal stiffness and positive Kernig sign. There was also a subcutaneous abscess at the sacral region. Cerebro-spinal fluid examination did not disclose pleocytosis, but showed abundant gram positive cocci, which were identified as pneumococci later. The initial diagnosis, thus, was pneumococcal meningitis, but further hematological evaluation revealed that he also had AMoL. He then developed DIC and acute respiratory failure, and eventually succumbed to death within 24 hours after admission. Autopsy findings were compatible with infectious meningitis, and also revealed leukemic cells invading the subarachnoid space, especially around the veins. These findings were suggestive of early stage of meningeal leukemia.
