Graves眼病合并真菌性角膜感染1例

A case of Graves ophthalmopathy accompanied by corneal fungus infection

报道1例应用大剂量糖皮质激素治疗Graves眼病后导致的真菌性角膜感染。一位31岁的甲状腺机能亢进同时伴有双眼突出的女性,视力下降、眼睑浮肿。首先应用抗甲状腺药物(甲巯咪唑),1个月后,突眼症状无改善,遂给予大剂量甲强龙冲击和曲安奈德球后注射以减轻症状。3个月后,该患者出现角膜溃疡,双眼无光感。1周后体温升高,最高达39.5℃,给予抗菌治疗后体温仍波动在36.7～37.3℃之间。角膜溃疡分泌物涂片可见真菌芽孢和菌丝,予甲亢、抗真菌和营养支持治疗。1个月后,患者双眼睑浮肿减轻、角膜溃疡面积减少,视力恢复到可有光感,体温降至正常。

To report a case of Graves ophthalmopathy with fungus infection in cornea. An 31 year old woman was suffered from hyperthyroidism with infiltrating exophthalmos, which led to reduced visual acuity and macular edema. Antithyroid drugs （ATD） were firstty administered, but hyperthyroidism did not improve after one-month treatment. High Dose Methylprednisolone and local injection of triamcinolone acetonide were then applied for three months while scanttered ulcer of cornea and light perception missing appeared. One week later, the patient was suffered from high fever, the highest of 39.5 ℃, fluctuating from 36.7 ℃ to 37.3 ℃ after anti-bacteria treatments. Hyphae and spores were found in the corneal secretion. Temperature and visual acuity recovered and the area of corneal ulcer reduced after combinition therapy of ATD,nutrition support and antifungal measures.