无植物性外伤史患者感染真菌性眼内炎1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2023.024

摘要/Abstract

摘要： 目的探究1例无植物性外伤史且诊断为真菌性眼内炎合并糖尿病患者的发病原因。方法 1例53岁男性患者因左眼视力急剧下降于外院进行糖皮质激素冲击治疗后无明显改善,15 d后来山东大学齐鲁医院眼科进行眼内液检测以明确致病菌,行左眼白内障超声乳化+玻璃体切割+眼内激光+硅油填充+玻璃体腔注药(伏立康唑0.02 mg)术。结果术后玻璃体液送检染色:真菌(-);矫正视力:右眼0.1,左眼 HM/5 cm;眼前后节情况稳定。结论镰刀菌是免疫低下患者内源性眼内炎的一种罕见但公认的病因,其感染途径多样,糖尿病及类固醇激素的应用可降低患者免疫系统稳定性,及时的诊断及抗真菌治疗对患者的预后非常重要。

关键词: 内源性眼内炎, 植物性外伤史, 糖尿病, 镰刀菌, 糖皮质激素

Abstract: Objective This report describes the pathogenesis in a patient with no history of vegetative trauma who was diagnosed with fungal endophthalmitis combined with diabetes mellitus. Methods A 53-year-old male patient with sharply decreased visual acuity in the left eye did not significantly improve after receiving glucocorticoid treatment for shock in an outside hospital. Fifteen d later, intraocular fluids analysis was performed in the Ophthalmology Department of Qilu Hospital of Shandong University to identify the causative organism. Moreover, ultrasonic emulsification for cataract, vitrectomy, intraocular laser, silicone oil filling, and intravitreal injection(voriconazole, 0.02 mg)were performed in the left eye. Results Postoperative vitreous fluid was submitted for staining: fungus(-). Corrected visual acuity: 0.1 in the right eye and HM/5 cm in the left eye and stable condition of the posterior anterior segment of the eye were found. Conclusion Fusarium is a rare but recognized cause of endogenous endophthalmitis in immunocompromised patients via various routes of infection. Diabetes mellitus and steroid hormone application could reduce the stability of the patient's immune system. Timely diagnosis and antifungal treatment were very important for improving the patient's prognosis.

Key words: Endogenous endophthalmitis, History of vegetative trauma, Diabetes mellitus, Fusarium, Glucocorticoids

中图分类号:

R771.2

李淑婷,赵慧,司明威,崔文轩,杨梦瑶,王红. 无植物性外伤史患者感染真菌性眼内炎1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(2): 103-108.

LI Shuting, ZHAO Hui, SI Mingwei, CUI Wenxuan, YANG Mengyao, WANG Hong. Fungal endophthalmitis in a patient with no history of vegetative trauma: a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(2): 103-108.

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