摘要
内源性真菌性眼内炎(endogenous fungal endophtalmitis,EFE)是最具破坏性的眼部感染之一,在临床上较少见。如诊断和治疗不及时,可严重损害患者视力,甚至需摘除眼球。由于EFE发病隐匿,病程较长,病原学涂片和培养阳性率较低,早期临床症状与葡萄膜炎相似,极易被误诊和漏诊,延误治疗时机。EFE最常见的感染灶来源为肝脏、肺、泌尿道、脑膜炎、胃肠道、心内膜以及骨髓。文章报道了一例腰椎感染致双眼内源性念珠菌性眼内炎的男性患者,66岁,因“右眼视力下降1周”首诊于眼科,专科检查见右眼玻璃体炎性混浊,初诊为右眼葡萄膜炎,予抗炎等治疗症状无好转,右眼视力持续下降,右眼前房穿刺抽液送检提示:热带念珠菌感染,之后左眼视力也逐渐下降,加之患者近期于骨科住院,术中腰椎间盘退变的纤维软骨组织DNA-病原微生物宏基因组检测结果示热带念珠菌,考虑双眼EFE,予全身及局部使用抗真菌药物联合双眼玻璃体切割手术,治疗后患者视力恢复良好,随访1年无复发。该病例及相关文献回顾,有助于加深临床医生对此类疾病的认识,为今后临床诊疗提供一定思路,也起到一定警示作用。
Fungal endophthalmitis is one of the most destructive eye infections and is relatively rare in clinical practice.If not diagnosed and treated promptly,it can severely damage vision and even lead to enucleation.Due to its insidious onset,long course,low positive rates in smears and cultures,and early clinical symptoms similar to uveitis,it is prone to misdiagnosis and missed diagnosis,leading to delayed treatment.A review of the literature indicates that the most common sources of EFE infection are the liver,lung,urinary tract,meningitis,gastrointestinal tract,endocarditis and osteomyelitis.In this paper,we report a case of lumbar spine infection causing bilateral candidal endophthalmitis in a 66-year-old male patient.He initially presented to the ophthalmology department of our hospital with a one-week history of decreased vision in the right eye,specialized examination revealed inflammatory opacity in the vitreous of the right eye,initially diagnosed as uveitis and treated with anti-inflammatory therapy without improvement.As the vision in the right eye continued to decline,aqueous humor aspiration from the anterior chamber of the right eye indicated infection with tropical Candida.Subsequently,the vision in the le?t eye also gradually decreased.Considering the recent hospitalization in the orthopedic department for lumbar disc degeneration,metagenomics analysis of fibrous cartilage tissue DNA during surgery detected tropical Candida,suggesting bilateral endogenous fungal endophthalmitis,The patient was treated with systemic and local antifungal medications in combination with bilateral vitrectomy surgery.A?ter treatment,the vision recovered well,and there was no recurrence during a one-year follow-up.The objective of this thesis is to deepen the understanding of clinicians on this type of disease by reporting this case and reviewing relevant literature,providing some insights for future clinical diagnosis and treatment,and serving as a warning.
作者
段茜(综述)
陈鸣(审校)
DUAN Xi;CHEN Ming(Eye School of Chengdu University of TCM,Chengdu 610603,China;Chengdu First People’s Hospital,Chengdu Integrated TCM&Western Medicine Hospital,Chengdu 610016,China)
出处
《眼科学报》
CAS
2024年第9期481-488,共8页
Eye Science
关键词
腰椎感染
念珠菌
眼内炎
葡萄膜炎
误诊
lumbar spine infection
Candida
endophthalmitis
Uveitis
misdiagnosis