Zapata Luis Fernando, Paulo José David, Restrepo Carlos A, Velásquez Luis Fernando, Montoya Andrés E Toro, Zapata Melissa A
Department of Ophthalmology Hospital Pablo Tobón Uribe.
Clin Ophthalmol. 2013;7:1459-61. doi: 10.2147/OPTH.S43695. Epub 2013 Jul 18.
To report an interesting case of infectious endotheliitis of presumed mycotic origin.
A case report of a 56-year-old male farmer who sought medical attention after a month-long evolution of irritative symptoms in his right eye, accompanied by visual acuity (VA) impairment. The patient received topical and oral broad-spectrum antibiotic treatment with no improvement before being referred to a cornea specialist, where he was found to have VA of 20/150 and was noted on biomicroscopy to have endothelial feathery coalescent lesions. The patient was admitted to the hospital for an aqueous humor sample and intravenous voriconazole.
The microbiological studies did not isolate any micro-organisms. However, clinical evidence of improvement was confirmed after 5 days of antimycotic intravenous therapy. Complete clinical resolution was achieved at 1 month after treatment completion with oral voriconazole, as evidenced by VA of 20/20 and disappearance of endothelial lesions.
Endothelial involvement by fungi is a rare condition. In this case, no microbes were isolated, but the characteristic morphology of the lesions, the history of onychomycosis, and the spectacular response to voriconazole turn this case into a valid presumptive diagnosis.
报告一例疑似霉菌性感染性内皮炎的有趣病例。
病例报告，一名56岁男性农民，右眼出现刺激性症状长达一个月并伴有视力（VA）损害后就医。患者接受了局部和口服广谱抗生素治疗，在转诊至角膜专科医生之前病情无改善，在该专科医生处检查发现其视力为20/150，生物显微镜检查发现有内皮羽毛状融合性病变。患者入院采集房水样本并接受静脉注射伏立康唑治疗。
微生物学研究未分离出任何微生物。然而，抗真菌静脉治疗5天后临床改善证据得到证实。口服伏立康唑治疗完成1个月后实现了完全临床缓解，视力为20/20且内皮病变消失即为证明。
真菌累及内皮是一种罕见情况。在此病例中，未分离出微生物，但病变的特征形态、甲癣病史以及对伏立康唑的显著反应使该病例成为一个有效的推定诊断。
