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化疗后免疫功能低下 9 岁儿童的脉络膜视网膜炎。

Chorioretinitis in a Post-chemotherapy Immunocompromised 9-Year-Old Child.

机构信息

Department of Ophthalmology, Rouen University Hospital, Rouen, France.

Department of Parasitology and Mycology, Rouen University Hospital, Rouen, France.

出版信息

Ocul Immunol Inflamm. 2023 Jul;31(5):1081-1084. doi: 10.1080/09273948.2022.2070502. Epub 2022 May 19.

Abstract

PURPOSE

To describe the management of bilateral chorioretinitis with in a post-chemotherapy immunocompromised young patient.

METHOD

A retrospective case report.

RESULT

A 9-year-old boy treated with chemotherapy for type 2 acute myeloid leukaemia was diagnosed with (formerly called ) fungaemia. Systematic ocular examination revealed chorioretinitis of the left eye becoming bilateral within the next 3 days. Therapy was based on systemic administration of voriconazole, amphotericin B and flucytosine associated with granulocytic stimulation without stabilizing the ophthalmological situation. Bilateral intravitreal injections of amphotericin B were administered. Voriconazole residual blood concentration was monitored to adjust daily dose. Final best corrected visual acuity in the right eye was 20/50 and 20/20 in the left eye.

CONCLUSION

This is the first report of chorioretinitis with . Because of its unpredictable pharmacokinetics, especially in pediatric population, therapeutic drug monitoring of voriconazole is essential to control fungal infection.

摘要

目的

描述一位化疗后免疫功能低下的年轻患者双侧性脉络膜视网膜炎的治疗经过。

方法

回顾性病例报告。

结果

一名 9 岁男孩因 2 型急性髓系白血病接受化疗治疗,被诊断为曲霉菌病(以前称为隐球菌病)菌血症。系统眼部检查发现左眼脉络膜视网膜炎在接下来的 3 天内发展为双侧性。治疗基于系统性伏立康唑、两性霉素 B 和氟胞嘧啶联合粒细胞刺激治疗,但未能稳定眼部病情。给予双侧玻璃体内注射两性霉素 B。监测伏立康唑血药浓度以调整每日剂量。右眼最佳矫正视力为 20/50,左眼为 20/20。

结论

这是首例曲霉菌病相关脉络膜视网膜炎的报告。由于其药代动力学不可预测,尤其是在儿科人群中,伏立康唑的治疗药物监测对于控制真菌感染至关重要。

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