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[蜂蜇伤后视神经炎]

[Optic neuritis after a bee sting].

作者信息

Zambrano-Infantino Rosanna de Carmen, Piñieríia-Gonsálvez Jean Félix, Montaño César, Rodríguez Carlos

机构信息

Servicio de Medicina Interna, Hospital Dr. Héctor Nouel Joubert, IVSS.

出版信息

Invest Clin. 2013 Jun;54(2):180-5.

Abstract

Optic neuritis is an acute inflammation of the optic nerve and, in its atypical form, is caused by inflammation of the optic nerve as part of infectious, immune, granulomatous, or contiguity processes. Hymenoptera stings (bees, wasps and ants) have been associated with different clinical presentations, ranging from local events to systemic manifestations, such as anaphylaxis, glomerulonephritis and central nervous system involvement (ischemic vascular lesions, optic neuritis and demyelinating lesions). This is a report of the case of a 62-year-old woman that after three days of being stung by a bee in the left lower eyelid, showed decreased visual acuity of both eyes and central scotoma, concomitant bilateral headache and eye pain, exacerbated by eye movements. The ophthalmological examination showed that visual acuity was decreased and the bilateral fundus examination revealed blurred optic disks edges. Hyperintense thickening of the left optic nerve was observed with an ocular MRI. Due to the clinical manifestations and epidemiological history, the diagnosis of bilateral optic neuritis was established. Treatment with pulses of 1 g/daily of methylprednisolone was initiated, for three days, with clinical improvement within 24 hours after receiving the first dose. Since 1960, cases of optic neuritis associated with hymenoptera stings have been documented, which take the form of anterior optic neuritis. A case of a patient who presented clinical features of bilateral optic neuritis after been stung by a bee, with a good clinical outcome after treatment with methylprednisolone is reported.

摘要

视神经炎是视神经的急性炎症,非典型形式是由视神经炎症引起,是感染、免疫、肉芽肿或邻近组织病变的一部分。膜翅目昆虫叮咬(蜜蜂、黄蜂和蚂蚁)与不同临床表现相关,从局部症状到全身表现,如过敏反应、肾小球肾炎和中枢神经系统受累(缺血性血管病变、视神经炎和脱髓鞘病变)。本文报告一例62岁女性病例,该患者左下眼睑被蜜蜂蜇伤三天后,出现双眼视力下降和中心暗点,伴有双侧头痛和眼痛,眼球活动时疼痛加剧。眼科检查显示视力下降,双侧眼底检查发现视盘边缘模糊。眼部MRI显示左侧视神经高强度增厚。根据临床表现和病史,确诊为双侧视神经炎。开始每日静脉注射1g甲泼尼龙冲击治疗,持续三天,首剂给药后24小时内临床症状改善。自1960年以来,已有膜翅目昆虫叮咬相关视神经炎病例的文献记载,均表现为前部视神经炎。本文报告一例患者被蜜蜂蜇伤后出现双侧视神经炎临床特征,经甲泼尼龙治疗后临床预后良好。

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