[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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A 76-year-old man with headache had taken oral analgesics for 2 months. On his date of admission, his consciousness rapidly deteriorated, and he was transported to the emergency room. A head CT scan showed inflammatory changes in the sphenoid sinus with bone erosion, and an MRI showed a subdural abscess mainly located in the posterior fossa. Based on blood serum and cerebrospinal fluid（CSF）tests, the patient was initially diagnosed with bacterial meningitis, and broad-spectrum antibacterial drugs were administered. Despite the antibiotics, his meningitis progressively worsened, and he died on the second day of hospitalization. Although his blood and CSF cultures were negative, Candida Albicans was identified in the culture from the sphenoid sinus mucosa. Ultimately, he was diagnosed with fungal meningitis pursuant to chronic sinusitis. Fungal meningitis should be suspected when paranasal sinusitis is present. Rapid diagnosis and early initiation of antifungal drugs may improve outcome.

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A 70-year-old male was administrated to the ER after found lying on the floor, presenting with a Glasgow Coma scale score of E1V1M5, tetraplegia, and sensory impairment in the facial region and limbs. Multiple bedsores were observed on the right side of the body. MR images of the brain showed large areas of hemorrhagic infarction, and ECG showed atrial fibrillation, which led to the diagnosis of cardiogenic cerebral embolism. Since admission blood tests showed elevated levels of inflammatory reactions. G. adiacens was identified from 1 set of blood culture. This organism is indigenous to the oral cavity and the gastrointestinal mucosa and is mainly known as a causative agent of infective endocarditis. Since the patient had ulceration of the upper lip mucosa in the oral cavity, and CT images showed a hemorrhoidal fistula contiguous with the rectum, and a left perianal abscess, these lesions were suspected to be potential sources of G. adiacens infection, triggering the development of infective endocarditis, which led to multiple hemorrhagic infarcts. When a patient presents with multiple hemorrhagic infarcts, nonvalvular atrial fibrillation, and elevated inflammatory response, IE must be considered.

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