• Akiko Fujita, Atsuko Kobayashi, Muneyoshi Tagami, Yasuaki Takano, Hiroki Matsuyama, and Mitsuyoshi Kawamura.
• Division of Anesthesiology, Saiseikai Suita Hospital, Osaka 564-0025.
• Masui. 2003 Oct 1;52(10):1110-4.

AbstractA 25-year-old woman complaining of general fatigue, headache, high fever, and nuchal rigidity, was admitted. She was diagnosed as pneumococcal meningoencephalitis after the cell culture of cerebrospinal fluid (CSF). Despite the administration of vancomycin (VCM), she fell into a coma without amelioration of the symptom. VCM was replaced by pipellaciline because antibacterial sensitivity showed the pneumococci were sensitive to the penicillins. She remained unconscious showing progressive hydrocephalus after the open drainage operation. The lumbar drainage at the L 4-5 level and the intrathecal administration of VCM were performed to improve the mal-circulation of CSF. After the procedure, the cell count of CSF showed a significant decrease and her consciousness level was recovered gradually. The patients with pneumococcal meningitis may occasionally require the lumbar drainage with the intrathecal administration of appropriate antibiotics, in case they fail to show response to the conventional therapy.

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