髄液中アデノシンデアミナーゼ活性の上昇から早期に診断された結核性髄膜炎の1例

Abstract

We report a case of tuberculous meningitis in a patient who was diagnosed with elevated activity of adenosine deaminase (ADA) in the cerebrospinal fluid (CSF) in the early stage of the disease. The patient was a 25-year-old female who was admitted to our hospital on Dec 10, 1996 because of fever, nausea, and headache. Tuberculous meningi- tis was strongly suspected based on clinical findings (including nuchal rigidity and de- creased deep tendon reflexes in the lower extremites) and CSF findings (initial pressure 280 mmH2O, cell count 493/μl, protein 116 mg/dl, glucose 41 mg/dl, tryptophan reaction posi- tive). Isoniazid, streptomycin, and rifampicin were administered. During treatment, no bacteria, fungi, or mycobacteria were detected in the CSF by both smear and culture examination. No mycobacterium tuberculosis RNA was detected using the Gen-ProbeTM Amplified Mycobacterium Tuberculosis Direct Test. However, the patient was diagnosed as having tuberculous meningitis based on the increased activity of ADA (9.9 IU/l) in the CSF in the early stage of the disease and she recovered completely. Thus, measurement of ADA in the CSF is a useful tool for early diagnosis and follow-up of tuberculous meningitis.