Pseudomembranous colitis (PMC) is known to be associated with the long-term administration of antibiotics, which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. However, antituberculosis agents are rarely reported as a cause of this disease. Besides, most cases of antituberculosis agent-induced PMC have been observed in patients with pulmonary tuberculosis but not with tuberculous meningitis. This report presents a case of PMC associated with antituberculosis therapy in a patient with tuberculous meningitis. A 29-year-old female patient was admitted due to headaches and diplopia that had lasted for 2 weeks. She had not recently received antimicrobial therapy. She was diagnosed with tuberculous meningitis by cerebrospinal fluid findings and neurologic examination, including brain imaging study. She was treated with standard antituberculosis agents (HERZ regimen: isoniazid, ethambutol, rifampicin, and pyrazinamide). After 11 days of HERZ, she developed a fever, sudden widespread skin eruption, and elevation of liver enzymes. Considering adverse drug reactions, antituberculosis agents were stopped. One week later, her symptoms were relieved. Thus, antituberculosis agents were reintroduced one at a time after liver function returned to normal. However, she presented with frequent mucoid, jelly-like diarrhea, and lower abdominal pain. Sigmoidscopy revealed multiple yellowish plaques with edematous mucosa, which were compatible with PMC. She was treated with oral vancomycin considering drug interactions. Symptoms were relieved and did not recur when all antituberculosis agents except pyrazinamide were started again. Therefore, when a patient complains of abdominal pain or diarrhea after initiation of antituberculosis therapy, the physician should consider the possibility of antituberculosis agent-associated PMC.

The aim of this study was to investigate the factors associated with cerebrospinal fluid (CSF) pleocytosis in pediatric enteroviral meningitis. A retrospective analysis of the medical records was performed in 281 patients under 18 years of age who were diagnosed with enteroviral meningitis by reverse transcription-polymerase chain reaction (RT-PCR) at Kwangju Christian Hospital from January to December 2016. Clinical symptoms and laboratory findings were compared according to the presence or absence of CSF pleocytosis. 112 children (39.9%) did not have CSF pleocytosis. When we compared the group of meningitis without pleocytosis and the group with pleocytosis, age were younger (< 2years), and the interval between onset of symptoms and the time of lumbar puncture was shorter (<24 hours), peripheral white blood cell counts were lower, but C-reactive protein (CRP) was higher in the group of meningitis without pleocytosis. Enteroviral meningitis should not be excluded even if CSF pleocytosis is not seen in patients. And enterovirus CSF RT-PCR should be performed with high suspicion in children younger than 2 years.

Bacterial meningitis is an uncommon complication of pituitary macroadenoma. Bacterial meningitis can occur in patients with pituitary macroadenoma who have received sphenoidal surgery or had cerebrospinal fluid (CSF) rhinorrhea. A 62-year-old male visited our hospital for headache and fever. Brain magnetic resonance imaging showed a pituitary macroadenoma. CSF study revealed acute bacterial meningitis. Intravenous antibiotics and hydrocortisone replacement therapy were started, and lead to good clinical outcome. Bacterial meningitis should be considered in patients with a pituitary macroadenoma who present with meningitis symptoms, even though in the absence of rhinorrhea or surgical history.

This study aimed to identify initial predictive factors of meningitis among the febrile neonates. Retrospective analysis was conducted on the clinical data of 147 cases who admitted the neonatal intensive care unit due to fever (temperature ≥ 38.0 ℃) from 2010 to 2014. Lumbar puncture was performed on every case before administration of antibiotics. 37 cases (25.2%) were diagnosed as meningitis, who included 7 cases of bacterial meningitis (4.8%). When we compared meningitis group with non-meningitis group (110 patients), moaning was statistically higher in meningitis group. In a comparison of bacterial meningitis with aseptic meningitis (30 patients), grunting, fever peak on admission day and C-reactive protein were significantly higher in bacterial meningitis group.

Retrospective analysis was conducted on the clinical data of 38 cases of bacterial meningitis that were proven by cerebrospinal fluid culture. Each case occurred by GBS (68.4%), Pneumococcus (15.8%), E. coli (5.3%), Streptococcus mitis (5.3%), Streptococcus bovis (2.6%), and Staphylococcus xylosus (2.6%). Compared to 28 cases with normal outcome, 10 cases who died or had adverse outcomes at hospital discharge were more likely to present with coma, seizure (before or within admission, focal, status epilepticus), require pressor or ventilator support, have initial peripheral blood leukocyte count less than 4,000/mm3 or neutrophil count less than 1,000/mm3, and have hydrocephalus or cerebral infarction by brain imaging.

The incidence of aseptic meningitis infection is ensuing and threatening the health of children. Enteroviruses are the major agents of aseptic meningitis and identification of virus has been a clue to diagnosis and epidemiology. The outbreak of aseptic meningitis occurred in Pusan, 1998. Patients were concentrated from April through November. Children were more susceptible than adults. Among 306 cases of specimens from stool, throat swab tested, only 7.2% were positive on virus isolation, 12 cases from stool and 10 from throat, respectively. All isolated 7 serotypes of viruses represented cytopathic effect on cultured cells. Three types of echovirus 6, 25, 30 and coxsackievirus B2, B3, B4, B6 were identified by neutralizing antibody test. Isolated coxsackievirus and echovirus were observed by an electron microscope with negative staining.