Arai Yusuke, Sato Yukihiro, Yoshida Atsushi, Kawashima Hidetoshi, Kaburaki Toshikatsu, Gomi Harumi
Department of Ophthalmology, Jichi Medical University, Tochigi, Japan.
Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
Clin Ophthalmol. 2014 Oct 21;8:2151-4. doi: 10.2147/OPTH.S70289. eCollection 2014.
Candida albicans subretinal abscess is extremely rare. To our knowledge, only one unilateral case has been reported. Herein, we report one bilateral case. Mixed bacterial infection was also suspected based on broad-range real-time polymerase chain reaction.
A 64-year-old man being treated with oral corticosteroids for interstitial pneumonia visited us for visual loss in the left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and 8/200 in the left eye. Funduscopy revealed round yellowish-white subretinal lesions with retinal hemorrhage in both eyes.
Broad-range polymerase chain reaction of the vitreous fluid from the left eye showed a high copy count of bacterial 16s ribosome RNA. Despite large doses of antibiotics, the abscess expanded and vision decreased to light perception in the left eye. Exenteration of the left eye was performed followed by microscopic examination showing Gram-negative bacilli, and C. albicans was also cultured. Antibiotics and the maximum doses of antifungal drugs were administered. However, the abscess in the right eye expanded, and BCVA decreased to 2/200. Vitrectomy and silicone oil tamponade were performed. Vitreous fluid culture revealed C. albicans. At 16 months follow-up, BCVA was stable at 4/200 with healing of the subretinal abscess under silicone oil.
Since C. albicans subretinal abscess is extremely rare and there was a concurrent mixed bacterial infection, diagnostic procedures in our bilateral case were more complicated than usual. C. albicans infection should be included in the differential diagnosis of subretinal abscesses.
白色念珠菌性视网膜下脓肿极为罕见。据我们所知，仅报告过一例单侧病例。在此，我们报告一例双侧病例。基于广谱实时聚合酶链反应，还怀疑存在混合细菌感染。
一名64岁男性因间质性肺炎正在接受口服皮质类固醇治疗，因左眼视力丧失前来就诊。右眼最佳矫正视力（BCVA）为20/20，左眼为8/200。眼底检查发现双眼均有圆形黄白色视网膜下病变伴视网膜出血。
左眼玻璃体液的广谱聚合酶链反应显示细菌16s核糖体RNA的拷贝数很高。尽管使用了大剂量抗生素，脓肿仍扩大，左眼视力降至光感。对左眼进行了眼球摘除术，随后显微镜检查显示为革兰氏阴性杆菌，同时也培养出了白色念珠菌。给予了抗生素和最大剂量的抗真菌药物。然而，右眼的脓肿扩大，BCVA降至2/200。进行了玻璃体切除术和硅油填充。玻璃体液培养显示有白色念珠菌。在16个月的随访中，BCVA稳定在4/200，视网膜下脓肿在硅油下愈合。
由于白色念珠菌性视网膜下脓肿极为罕见，且存在并发混合细菌感染，我们这例双侧病例的诊断过程比通常情况更为复杂。白色念珠菌感染应纳入视网膜下脓肿的鉴别诊断。
