Giarmoukakis Athanassios, Blazaki Styliani, Chalkia Aikaterini, Plaka Argyro, Bontzos Georgios, Tsilimbaris Miltiadis
Department of Ophthalmology, University of Crete, Heraklion, Greece.
Rom J Ophthalmol. 2019 Apr-Jun;63(2):178-183.
Endogenous endophthalmitis is a serious sight-threatening disease. Common causes include immunocompromised state and intravenous drug use, permitting opportunistic pathogens to reach the eye through the blood stream. We reported a rare case of a presumed simultaneous opportunistic intraocular fungal and cytomegalovirus (CMV) infection. A 67-year-old male patient with a recent history of hospitalization due to pneumonia, presented to our department with bilateral loss of vision. Ocular examination revealed low visual acuity, signs of vitritis with chorioretinal infiltrations and cotton ball colony-like lesions, bilaterally. A bilateral endogenous fungal endophthalmitis was suspected and topical and systemic antifungal treatment was initiated. Nevertheless, vitreous and blood cultures were negative for fungi and other bacteria, while serological examinations revealed primary infection with CMV. Following vitrectomy, polymerase chain reaction (PCR) of vitreous washings confirmed the intraocular infection with CMV. Treatment was modified, including intravenous administration of Gancyclovir. In the following days, the patient's clinical signs and visual acuity improved remarkably. A case of a presumed mixed fungal and CMV intraocular infection was presented. High level of suspicion with prompt diagnosis and aggressive combination treatment led to a favorable result.
内源性眼内炎是一种严重的视力威胁性疾病。常见病因包括免疫功能低下状态和静脉吸毒，使机会性病原体通过血流到达眼部。我们报告了一例罕见的推测为同时发生的机会性眼内真菌和巨细胞病毒（CMV）感染病例。一名67岁男性患者近期因肺炎住院，前来我科就诊时双眼视力丧失。眼部检查发现双眼视力低下，有玻璃体炎体征，伴有脉络膜视网膜浸润和棉球样病灶。怀疑为双侧内源性真菌性眼内炎，开始局部和全身抗真菌治疗。然而，玻璃体和血培养真菌及其他细菌均为阴性，而血清学检查显示为CMV原发感染。玻璃体切除术后，玻璃体冲洗液的聚合酶链反应（PCR）证实眼内感染CMV。治疗方案调整为包括静脉注射更昔洛韦。在接下来的几天里，患者的临床症状和视力明显改善。本文报告了一例推测为混合性真菌和CMV眼内感染的病例。高度怀疑、及时诊断和积极的联合治疗取得了良好效果。
