以眼部症状为首发的儿童EB病毒感染的临床诊疗观察

Clinical Diagnosis and Treatment of Epstein-Barr Virus Infection Initially Manifested as Ocular Diseases in Children

目的探讨儿童EB病毒(EBV)感染继发眼病的疾病谱、临床特征及治疗方法。方法回顾性分析2015年1月至2018年1月在武汉儿童医院眼科首诊并最终确诊为原发性EBV感染的23例患儿临床资料。对症状、体征、实验室检查结果、眼部微生物学检测结果、眼部影像学特征及治疗过程与预后等临床资料进行总结分析。结果EBV感染继发眼部疾病谱包括急性泪囊周围炎13例13只眼(56.52%)、急性泪囊炎9例9只眼(39.13%)、急性泪腺炎1例2只眼(4.35%)。眼部临床表现包括眼睑和(或)泪囊区皮肤红肿23例(100.00%)、溢泪9例(39.13%)、眼分泌物增多5例(21.74%)、皮下脓肿5例(21.74%)等。CT检查显示,急性泪囊周围炎患者眼睑及泪囊区团片状软组织密度影,急性泪囊炎患者泪囊肿胀、鼻泪管扩张,急性泪腺炎患者泪腺肿大。全身EBV感染疾病谱包括传染性单核细胞增多症(IM)10例(43.48%),EBV相关噬血淋巴组织细胞增生症(EBV-HLH)1例(4.35%),其他非典型性EBV感染12例(52.17%)。全身临床表现包括颈部淋巴结肿大(95.65%)、发热(43.48%)、扁桃体炎(56.52%)等。20例予以单纯保守治疗,2例手术治疗引流皮下脓肿,1例转科治疗。临床治愈出院4例(17.39%),好转出院18例(78.26%)。好转出院患儿的眼部表现主要为泪囊区可扪及条索样或颗粒感硬结。至随访结束,除1例转移患者失访外,余22例患者预后良好。结论儿童EBV感染常继发泪器系统的感染。既往无溢泪或眼睑红肿等症状的儿童患急性泪囊炎、急性泪囊周围炎以及急性泪腺炎时需要明确是否存在EBV感染。一旦确诊EBV感染,应进行积极对因治疗,大多数通过保守治疗可以治愈,少部分病例需要手术治疗,总体预后良好。

Objective To investigate the clinical features and treatment of ophthalmopathy secondary to EB virus(EBV)infection in children.Methods The clinical data of 23 children with primary EBV infection who were first diagnosed in Ophthalmopathy Department from January 2015 to January 2018 were analyzed retrospectively.The data of symptoms,signs,laboratory examination results,eye microbiological examination results,eye imaging features,treatment process and prognosis were summarized and analyzed statistically.Results The ocular diseases secondary to EBV infection included acute peridacryocystitis in 13 eyes(56.52%)of 13 cases,acute dacryocystitis in 9 eyes(39.13%)of 9 cases and acute dacryoadenitis in 2 eyes(4.35%)of 1 case.The chief symptoms of the eyes included skin redness and swelling in 23 cases(100.00%),tearing in 9 cases(39.13%),increased secretion in 5 cases(21.74%)and subcutaneous abscess in 5 cases(21.74%),etc.CT demonstrated soft tissue mass in eyelid and lacrimal sac of acute peridacryocystitis cases,or nasolacrimal duct dilatation in cases of acute dacryocystitis,lacrimal gland swelling in the case of acute dacryoadenitis.The disease spectrum of systemic EBV infection included infectious mononucleosis in 10 cases(43.48%),EBV-associated hemolymphoid histiocytosis in 1 case(4.35%)and other atypical EBV infection in 12 cases(52.17%).Systemic symptoms included lymphadenopathy(95.65%),fever(43.48%),tonsillitis(56.52%),etc.Twenty cases were treated with conservative treatment,2 cases received surgical drainage of the subcutaneous abscess,and 1 case was transferred.Four cases(17.39%)were cured and 18 cases(78.26%)were improved.The main ocular manifestations of the children with improvement were cord-like sclerosis in the lacrimal sac area.At the end of follow-up,except for one patient who was lost to follow-up after transfer,22 patients had a good prognosis.Conclusion EBV infection in children is often secondary to lacrimal apparatus infection.EBV infection should be considered in previously asymptomatic children presenting with acute peridacryocystitis,acute dacryocystitis and acute dacryoadenitis.Once EBV infection is diagnosed,active treatment should be carried out,most conservative treatment can be cured,a small number of cases need surgical treatment,and the overall recovery is good.