Isshiki Yoshihiko, Kimura Tohru, Yokoyama Mitsunobu, Kimura Wataru, Syoge Keisuke, Ryu Momoyoshi, Uchida Yoshiko, Yoshiki Hiroka, Suzuki Takashi
Kimura Eye & Internal Medicine Hospital, Hiroshima, Japan.
Nippon Ganka Gakkai Zasshi. 2007 Sep;111(9):741-4.
We report a case of fungal endophthalmitis which developed after subtenon injections of triamcinolone acetonide (TA).
A 63-year-old man had Graves' ophthalmopathy. He had received subtenon injections of TA in his left eye. He was admitted to Kimura Eye & Internal Medicine Hospital because of a subconjunctival abscess with inflammatory cells in the anterior chamber. Although we treated it as a suspected bacterial infection at the first visit, it deteriorated rapidly. Because prolonged antibiotics and antifungal therapy seemed ineffective, we performed diagnostic surgery. The lower sclera around the subtenon injections of TA was hard and thick, and a white spotty lesion and retinal detachment were seen on the lower retina. A culture of the Tenon sac showed filamentous fungus. After the surgery the subconjunctival abscess recurred because intravenous antifungal therapy had been discontinued. A culture of the abscess identified Alternaria sp. The subconjunctival abscess, thickened sclera, and retinal exudate were limited to the region of the sub-Tenon injection of TA, We conclude that the sclera had been permeated by hyphae of Alternaria sp.
In this case, critical infection was caused by the sub-Tenon injections of TA.
我们报告一例在球后注射曲安奈德（TA）后发生的真菌性眼内炎病例。
一名63岁男性患有格雷夫斯眼病。他曾在左眼接受球后TA注射。因前房出现伴有炎症细胞的结膜下脓肿，他入住木村眼科与内科医院。尽管我们在初次就诊时将其作为疑似细菌感染进行治疗，但病情迅速恶化。由于长期使用抗生素和抗真菌治疗似乎无效，我们进行了诊断性手术。TA球后注射部位周围的下部巩膜坚硬增厚，下部视网膜可见白色斑点状病变和视网膜脱离。Tenon囊培养显示丝状真菌。手术后，由于停止了静脉抗真菌治疗，结膜下脓肿复发。脓肿培养鉴定为链格孢属。结膜下脓肿、增厚的巩膜和视网膜渗出仅限于TA球后注射区域。我们得出结论，链格孢属的菌丝已渗透到巩膜。
在本病例中，球后注射TA导致了严重感染。
