视网膜浸润灶为主要表现的葡萄膜炎1例

A case of uveitis with retinal infiltrations as the main manifestation

患者男性,38岁,因“左眼红伴视力下降1周”就诊。最佳矫正视力:右眼1.0,左眼0.04;双眼眼压正常;右眼查体未见明显异常;左眼轻度混合充血,角膜明,前房少量细胞,玻璃体大量炎性混浊,视网膜散在黄白色病灶。光学相干层析成像(OCT)提示左眼视网膜中高反射浸润灶伴视网膜下渗出。荧光素眼底血管造影(FFA)提示晚期右眼视乳头荧光染色,左眼视乳头及视网膜静脉渗漏明显。血液风湿免疫化验指标提示血沉轻度升高,免疫相关自身抗体阴性。感染指标人类免疫缺陷病毒(HIV)、梅毒螺旋体颗粒凝集试验(TPPA)+快速血浆反应(RPR)阴性,T淋巴细胞酶联免疫斑点法(T-SPOT)阴性;房水病毒及弓形体抗体滴度未见明显升高;血培养提示痤疮丙酸杆菌生长。初步诊断为左眼葡萄膜炎(细菌感染性?)。患者否认手术外伤及全身疾病史,否认猫狗接触史。经局部激素、抗生素滴眼液治疗后前后节炎症均呈现好转趋势。追问病史,患者既往眼部有类似炎症发作史,滴眼液治疗后好转;且患者有频繁发作的口腔溃疡史。最终修正诊断为白塞病,予免疫抑制剂及激素治疗后,炎症逐渐稳定。讨论体会:白塞病可表现为视网膜浸润病灶,需结合患者的病史、病程特征及全身情况,与感染性视网膜浸润灶进行鉴别。

A 38-year-old man was admitted with a history of eye redness and decreased vision in the left eye for 1 week.The best corrected visual acuity was 1.0 in the right eye and 0.04 in the left eye;the intraocular pressure in both eyes was normal.The anterior and posterior segment exam of the right eye was unremarkable.The left eye was found with slight conjunctival hyperemia,some cells in the anterior chamber,obviously inflammatory opacity in the vitreous,and retinal yellow-white lesions.Optical coherent tomography(OCT)showed medium-to-high reflective retinal infiltrations with subretinal exudation in the left eye.Fundus fluorescence angiography(FFA)showed fluorescent staining of the papilla in the right eye,and obvious leakage at the papilla and retinal vein of the left eye in the late stage.Blood test showed mildly elevated erythrocyte sedimentation rate,and negative autoantibodies.The HIV,TPPA+RPR,and T-SPOT test were negative;The titers of viral and toxoplasma antibody were not significantly increased in the aqueous humor.Blood cultures suggested growth of Propionibacterium acnes.The Initial diagnosis was uveitis(bacterial infectious?)of the left eye.The patient denied histories of surgery,trauma,systemic diseases,or any history of contact with dogs or cats.After treatment with eyedrops of steroids and antibiotics,the inflammation of the anterior and posterior segments slightly relieved.Further medical history was investigated.The patient suffered from similar inflammatory attacks in both eyes before,with improvement after eyedrops administration;besides,the patient had a history of frequent oral ulcers.The diagnosis was then revised to Behcet's disease,and the inflammation gradually stabilized after treatment with immunosuppressant and steroids.Discussion and experience:Behcet's disease can be manifested as retinal infiltration lesions,which need to be distinguished from infectious retinal lesions,in combination with the patient's medical history,disease course and systemic conditions.