Quintyn J C, Poupelin S, Fajoles-Vasseneix C, Brasseur G
Service d'Ophtalmologie, CHU de Rangueil, Toulouse.
J Fr Ophtalmol. 2006 Nov;29(9):e24.
Meningococcus endophthalmitis is exceptional. We report a case of ocular damage following type C meningococcus septicemia with no meningitis. A 20-year-old man reported to the emergency unit for polyarthritis pain in various joints, associated with chills, nausea, and diarrhea without fever. Ophthalmological examination revealed uveitis. A few days later, endogenous endophthalmitis was suggested because of a worsening general condition and fever spells to 39 degrees C. A hemoculture sampled on the patient's admission 4 days earlier revealed Neisseria meningitidis positivity. Meningococcus septicemia with no meningitis was diagnosed. Before the introduction of antibiotics, meningococcus meningitis was unfortunately frequent and ocular septic embolism was not a rare occurrence. The diagnosis of meningococcemia was delayed in our patient because of the atypical symptomatology and ocular manifestations in the forefront. As with any endogenous endophthalmitis, prognosis is bleak and it should be raised whenever suspected uveitis does not react to standard treatment.
脑膜炎球菌性眼内炎极为罕见。我们报告一例C型脑膜炎球菌败血症后出现眼部损害但无脑膜炎的病例。一名20岁男性因多关节的多关节炎疼痛前往急诊科就诊,伴有寒战、恶心和腹泻,但无发热。眼科检查发现葡萄膜炎。几天后,由于全身状况恶化且体温升至39摄氏度,提示发生了内源性眼内炎。患者入院4天前采集的血培养显示脑膜炎奈瑟菌阳性。诊断为无脑膜炎的脑膜炎球菌败血症。在抗生素问世之前,不幸的是,脑膜炎球菌性脑膜炎很常见,眼部脓毒性栓塞也并非罕见。由于非典型症状和眼部表现较为突出,我们这位患者的脑膜炎球菌血症诊断被延迟。与任何内源性眼内炎一样,预后不佳,每当怀疑葡萄膜炎对标准治疗无反应时,都应提高警惕。