Arroyo Jorge G, Bula Deisy V, Grant Calvin A, Murtha Timothy
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Brigham & Women's Hospital, and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02114, USA.
Jpn J Ophthalmol. 2004 Jan-Feb;48(1):30-3. doi: 10.1007/s10384-003-0008-0.
To describe the clinical and histopathologic findings in a patient with bilateral Candida albicans endophthalmitis due to an infected deep venous thrombus.
A 43-year-old patient with bilateral Candida albicans endophthalmitis due to an infected central venous thrombus. The patient's ophthalmology and hospital charts were reviewed. Histopathologic sections of the Candida albicans retinal granuloma were examined under light microscopy.
Our patient had multiple blood cultures positive for Candida albicans owing to an infected subclavicular venous thrombosis. Bilateral Candida albicans endophthalmitis was diagnosed. Bilateral vitrectomy and membrane peeling for macular traction retinal detachments were performed. In the right eye, a large retinal granuloma was excised during surgery to adequately relieve traction on the macula. Vision improved in both eyes after surgery. Histopathologic findings revealed branching hyphae surrounded by giant cells, endothelial cell-lined vascular channels, and inflammatory cells.
This is the first report of an infected deep venous thrombosis causing bilateral endogenous endophthalmitis. Appropriate management of these patients requires clear differentiation between endogenous chorioretinitis and endophthalmitis. Patients with documented fungemia should have a dilated fundus examination on a regular basis until complete clearance of the infection.
描述一例因感染性深静脉血栓导致双侧白色念珠菌性眼内炎患者的临床和组织病理学表现。
一名43岁患者因感染性中心静脉血栓导致双侧白色念珠菌性眼内炎。查阅了该患者的眼科和医院病历。在光学显微镜下检查了白色念珠菌视网膜肉芽肿的组织病理学切片。
我们的患者因锁骨下静脉血栓感染，多次血培养白色念珠菌呈阳性。诊断为双侧白色念珠菌性眼内炎。进行了双侧玻璃体切除术及黄斑牵引性视网膜脱离的膜剥除术。右眼在手术中切除了一个大的视网膜肉芽肿，以充分缓解黄斑部的牵引。术后双眼视力均有改善。组织病理学结果显示有分支菌丝，周围有巨细胞、内皮细胞衬里的血管通道和炎性细胞。
这是首例关于感染性深静脉血栓导致双侧内源性眼内炎的报告。对这些患者进行恰当的治疗需要明确区分内源性脉络膜视网膜炎和眼内炎。有真菌血症记录的患者应定期进行散瞳眼底检查，直至感染完全清除。
