Ohta Masahiko, Yoneda Yukihiro, Kita Mihori, Ichikawa Keiji, Kageyama Yasufumi
Division of Neurology, Hyogo Prefectural Amagasaki Hospital.
Rinsho Shinkeigaku. 2013;53(1):37-40. doi: 10.5692/clinicalneurol.53.37.
Endogenous endophthalmitis may be a rare condition in acute meningo-encephalitis. A 69-year-old compromised adult abruptly developed septic bacteremia and meningo-encephalitis by Klebsiella pneumoniae. After an improvement from initial conscious disturbance and systemic inflammatory unstable vital conditions by treatment of intensive antibiotic medications, severe unilateral endogenous endophthalmitis with impaired visual acuity was diagnosed by detailed ophthalmological assessments and it deteriorated rapidly. After early vitreous surgery with anti-biotic direct injection, the patient successfully regained visual acuity of 20/200. Among the organisms of endogenous bacterial endophthalmitis, Klebsiella pneumoniae is the worst pathogen mostly resulting in vision loss or enucleation despite any aggressive treatments. The neuro-physicians should recognize the presence of refractory endophthalmitis by Klebsiella pneumoniae, even if clinically asymptomatic, because prompt ophthalmologic diagnosis and managements may improve the outcome.
内源性眼内炎在急性脑膜脑炎中可能是一种罕见的病症。一名69岁的免疫功能低下成年人突然发生了由肺炎克雷伯菌引起的败血症性菌血症和脑膜脑炎。通过强化抗生素治疗，患者最初的意识障碍和全身炎症导致的不稳定生命体征有所改善，但经详细眼科评估后诊断为严重的单侧内源性眼内炎，视力受损，且病情迅速恶化。在早期进行玻璃体手术并直接注射抗生素后，患者成功恢复到了20/200的视力。在内源性细菌性眼内炎的病原体中，肺炎克雷伯菌是最糟糕的病原体，尽管进行了积极治疗，大多仍会导致视力丧失或眼球摘除。神经科医生应认识到肺炎克雷伯菌引起的难治性眼内炎的存在，即使临床上无症状，因为及时的眼科诊断和治疗可能会改善预后。
