日本新生児成育医学会雑誌　第33巻　第1号　128 ～ 135頁（2021年）

日本新生児成育医学会雑誌　33(1)：128-135；2021　

受付日：2020．09．28

受理日：2021．01．06

脳表に多発性の出血を合併した早発型B 群溶血性連鎖球菌髄膜炎の1 例

Early Onset Group B Streptococcal Meningitis with Multiple Bleeding Spots on the Brain Surface：a Case Report

＊ 1 筑波大学附属病院　小児科，＊ 2 筑波大学　医学医療系　小児科

＊ 1 Department of Pediatrics, University of Tsukuba Hospital，＊ 2 Department of Child Health, Faculty of Medicine, University of Tsukuba

角田侑以＊ 1・金井　雄＊ 1 ＊ 2・畑野舞子＊ 1・花木麻衣＊ 1・中村由里＊ 1・永藤元道＊ 1・竹内秀輔＊ 1・梶川大悟＊ 1・日高大介＊ 1・藤山　聡＊ 1・宮園弥生＊ 1 ＊ 2・高田英俊＊ 1 ＊ 2

Yui TSUNODA ＊ 1，Yu KANAI ＊ 1 ＊ 2，Maiko HATANO ＊ 1，Mai HANAKI ＊ 1，Yuri NAKAMURA ＊ 1， Motomichi NAGAFUJI ＊ 1，Syusuke TAKEUCHI ＊ 1，Daigo KAJIKAWA ＊ 1，Daisuke HITAKA ＊ 1， Satoshi FUJIYAMA ＊ 1，Yayoi MIYAZONO ＊ 1 ＊ 2，Hidetoshi TAKADA ＊ 1 ＊ 2

Key Words：group B streptococcus，meningitis，cerebral hemorrhage，brain ultrasound

　脳表に多発性の出血を合併した早発型B 群溶血性連鎖球菌（Group B streptococcus：GBS）髄膜炎を経験した。症例は在胎39 週2 日，出生体重3,266g の男児。生後35 時間に発熱，呻吟，多呼吸を認め，当院に新生児搬送された。入院時検査でGBS 髄膜炎と診断し，日齢2 に敗血症性ショックに対し交換輸血を施行した。同日新生児発作が出現したが，抗痙攣薬3 剤の使用により頓挫した。頭部超音波検査で日齢3 より頭頂葉表面に高エコー輝度の結節が出現し，次第に多発するようになった。日齢11 の頭部造影MRI より脳表の多発性の出血と診断し，出血の機序は髄膜からの炎症が直接脳実質に波及したものと考えられた。
　新生児敗血症の治療として，交換輸血，血液浄化療法を行う上で，GBS 髄膜炎の急性期に頭蓋内出血をきたすことは留意するべき病態であると考えた。早期発見には脳表の所見に注目した頭部超音波検査が有用である。

We report a case of early onset group B streptococcal （GBS） meningitis with multiple bleeding spots on the brain surface. A male child was born at a gestational age of 39 weeks 2 days with a birth weight of 3,266 grams. He presented with fever, grunting, and tachypnea at 35 hours after birth, for which he was transferred to our hospital. He was diagnosed with GBS meningitis based on blood and cerebrospinal fluid examinations. At third day of life, he received an exchange transfusion for septic shock. He also developed seizures, for which three anticonvulsant drugs were administered. At fourth day of life, brain ultrasound was performed, which revealed nodules with high echogenicity on the parietal lobe surface, which gradually increased in number and size. These nodules initially found on ultrasonography were later diagnosed as hemorrhagic lesions on brain magnetic resonance imaging on twelfth day of life. Moreover, the bleeding was suspected to be due to the direct infiltration of inflammation from the meninges into the brain parenchyma. While deciding on exchange transfusion or hemofiltration for the treatment of neonatal sepsis, it is necessary to consider that intracranial hemorrhage can occur in the acute phase of GBS meningitis. Timely brain ultrasound focused on the brain surface is essential for the early detection of intracranial hemorrhage.