Chou Brian, McKay K Matthew, Leveque Thellea K
Department of Ophthalmology, University of Washington, Box 359608 325 Ninth Ave Seattle, WA, 98104-2499, USA.
Am J Ophthalmol Case Rep. 2022 Jan 20;25:101257. doi: 10.1016/j.ajoc.2022.101257. eCollection 2022 Mar.
To report a case of Sporothrix shenkii endophthalmitis successfully treated with local thermal therapy after failure of conventional systemic and local antifungal therapy.
A 44-year-old female on long-term immunosuppressive therapy for extrapulmonary sarcoidosis presented with bilateral Sporothrix shenkii endophthalmitis. Despite prolonged systemic antifungal therapy, numerous intraocular antifungal injections, and surgical intervention with vitrectomy and lensectomy, her condition worsened with progressively increased fungal burden in the anterior chamber. At the patients request, interventional ocular procedures including intraocular injections were withdrawn and enucleation was considered secondary to pain and severe scleral thinning. Local thermal therapy was initiated as a palliative measure, supported by evidence for Sporothrix growth inhibition above 38.5 °C and efficacy with cutaneous Sporothrix. Initiation of ocular thermal therapy with a commercially available electronic heat mask was followed by a dramatic and durable improvement in pain and fungal burden.
Thermal therapy may be an effective alternative for Sporothrix endophthalmitis affecting the anterior segment with lower risk for toxicity than intraocular injection of antimicrobial therapy.
报告1例申克孢子丝菌性眼内炎患者，在传统全身及局部抗真菌治疗失败后，经局部热疗成功治愈。
一名44岁女性，因肺外结节病接受长期免疫抑制治疗，出现双侧申克孢子丝菌性眼内炎。尽管进行了长时间的全身抗真菌治疗、多次眼内抗真菌注射，以及玻璃体切除术和晶状体切除术等手术干预，但其病情仍恶化，前房内真菌负荷逐渐增加。应患者要求，包括眼内注射在内的介入性眼科手术被取消，考虑到疼痛和严重的巩膜变薄，拟行眼球摘除术。局部热疗作为一种姑息治疗措施启动，依据是有证据表明申克孢子丝菌在38.5℃以上生长受到抑制，且热疗对皮肤孢子丝菌病有效。使用市售电子热面罩开始眼内热疗后，疼痛和真菌负荷得到显著且持久的改善。
热疗可能是治疗累及眼前节的孢子丝菌性眼内炎的一种有效替代方法，其毒性风险低于眼内注射抗菌治疗。
