Uyhazi Katherine E, Kolomeyer Anton M, Gray Iga N, Traband Anastasia, Kohli Anita A, O'Brien Joan M, Maguire Albert M
J Pediatr Ophthalmol Strabismus. 2017 Jun 29;54:e42-e46. doi: 10.3928/01913913-20170531-08.
The authors describe a case of presumed endogenous fungal endophthalmitis in an immunocompetent pediatric patient with acute lymphoblastic leukemia. A 15-year-old boy with a history of high-risk B-cell acute lymphoblastic leukemia status post-chemotherapy presented with acute changes in vision in his left eye. Fundus examination revealed a white bi-lobed chorioretinal lesion with overlying vitritis and associated subretinal fluid. Magnetic resonance imaging of the brain revealed small ring-enhancing lesions in the right parietal and left occipital lobes. Blood, cerebrospinal fluid, aqueous, and vitreous cultures were all negative. Bone marrow and vitreous cytology were negative for malignant cells. The patient was treated for presumed fungal endophthalmitis with systemic and intravitreal voriconazole, followed by pars plana vitrectomy with intravitreal voriconazole and amphotericin B injections. The chorioretinal lesion resolved and visual acuity recovered to 20/20. Chorioretinal infiltrates in a patient with leukemia may require treatment even in the absence of a definitive diagnostic test result. Intervention should be guided by risk analysis and clinical judgment. [J Pediatr Ophthalmol Strabismus. 2017;54:e42-e46.].
作者描述了一例免疫功能正常的急性淋巴细胞白血病儿科患者发生的疑似内源性真菌性眼内炎病例。一名15岁有高危B细胞急性淋巴细胞白血病化疗史的男孩，左眼视力出现急性变化。眼底检查发现一个白色双叶脉络膜视网膜病变，伴有表层玻璃体炎和相关的视网膜下液。脑部磁共振成像显示右侧顶叶和左侧枕叶有小的环形强化病变。血液、脑脊液、房水和玻璃体培养均为阴性。骨髓和玻璃体细胞学检查未发现恶性细胞。该患者因疑似真菌性眼内炎接受了全身及玻璃体内伏立康唑治疗，随后行玻璃体切除术并玻璃体内注射伏立康唑和两性霉素B。脉络膜视网膜病变消退，视力恢复至20/20。白血病患者即使在没有明确诊断检测结果的情况下，脉络膜视网膜浸润也可能需要治疗。干预应基于风险分析和临床判断。[《小儿眼科与斜视杂志》。2017年；54:e42-e46。]
