Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan.
Department of Ophthalmology, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-08304, Japan.
BMC Infect Dis. 2020 Aug 3;20(1):566. doi: 10.1186/s12879-020-05294-y.
Subtenon injection of triamcinolone acetonide (STTA) has been widely adopted in the clinical setting of ophthalmology and its infectious complications are rare. However, orbital abscess following STTA has been reported in seven cases. Furthermore, although eye infections due to Exophiala species are uncommon, there have been 19 cases to date. E. jeanselmei, E. phaeomuriformis, E. werneckii, and E. dermatitidis have been reported to cause human eye infections; however, to the best of our knowledge, orbital abscess caused by E. dermatitidis has not yet been reported. We describe the first documented case of fungal orbital abscess caused by E. dermatitidis following STTA. We also review the related literature of orbital abscess following STTA, as well as eye infections caused by the four Exophiala species.
The patient was a 69-year-old Japanese woman with diabetic mellitus. She had a macular oedema in her right eye, which occurred secondary to branch retinal vein occlusion. An orbital abscess caused by E. dermatitidis occurred 4 months after the second STTA for the macular oedema, which was successfully treated by a surgical debridement and systemic administration of voriconazole.
Our findings in the patient and from our literature survey caution ophthalmologists to the fact that STTA can cause fungal orbital infections, especially in diabetic patients. Furthermore, surgical treatment is one of the most important risk factors.
曲安奈德经眼窝下注射（STTA）已在眼科临床中广泛应用，其感染并发症罕见。然而，已有 7 例报道称该操作后会发生眼眶脓肿。此外，虽然外瓶霉属物种引起的眼部感染并不常见，但迄今为止已有 19 例。E. jeanselmei、E. phaeomuriformis、E. werneckii 和 E. dermatitidis 已被报道可引起人类眼部感染；然而，据我们所知，E. dermatitidis 引起的眼眶脓肿尚未被报道。我们描述了首例经 STTA 后真菌性眼眶脓肿由 E. dermatitidis 引起的病例。我们还回顾了与 STTA 后眼眶脓肿以及由这四种外瓶霉属物种引起的眼部感染相关的文献。
患者为 69 岁日本女性，患有糖尿病。她右眼出现黄斑水肿，继发于视网膜分支静脉阻塞。第二次 STTA 治疗黄斑水肿后 4 个月，发生 E. dermatitidis 引起的眼眶脓肿，经手术清创和伏立康唑全身治疗后痊愈。
我们对该患者的观察结果以及文献调查结果警示眼科医生 STTA 可能引起真菌性眼眶感染，尤其是在糖尿病患者中。此外，手术治疗是最重要的危险因素之一。
