Dhiman Richa, Sharma Nancy, Chauhan Jyoti
Department of Ophthalmology, Government Medical College, Chandigarh, India.
Department of Ophthalmology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India.
Taiwan J Ophthalmol. 2023 Jan 5;13(1):84-87. doi: 10.4103/tjo.TJO-D-22-00101. eCollection 2023 Jan-Mar.
The purpose of the study was to report a unique case of keratitis presenting as a ring infiltrate in an adolescent girl. A 16-year-old girl presented with decreased vision in the right eye preceding an episode of fever with a rash associated with burning micturition. The patient was examined after taking appropriate consent. The slit-lamp examination revealed a ring-shaped corneal infiltrate with an epithelial defect in her right eye. Corneal scrapings were sent for microbiological evaluation which revealed Gram-negative rods and culture identified it as extended-spectrum beta-lactamase-producing colonies. The patient showed a good response to topical fortified amikacin and tobramycin. For her systemic complaints, the pediatrician did a thorough investigative workup out of which blood culture showed growth of . Hence, intravenous antibiotics were given based on the antibiogram report and the patient recovered. After 2 weeks, a paracentral infiltrate in her left eye was noted followed by anterior uveitis. The patient responded well to the topical course of steroids along with aminoglycosides. Four months later, she had a recurrence of anterior uveitis in the right eye preceded by fever. Blood investigations were negative. Hence, a diagnosis of recurrent uveitis secondary to endogenous infection was made and the patient was successfully treated with a short course of topical steroids. The patient is on follow-up for the past 6 months and maintaining the best-corrected visual acuity of 20/20 OU with normal intraocular pressure and quiet anterior chamber (AC). This is the first clinical report describing a ring infiltrate in endogenous keratitis and emphasizes thorough workup for prompt treatment.
本研究的目的是报告一例青春期女孩表现为环形浸润的角膜炎独特病例。一名16岁女孩在出现发热伴皮疹及尿痛发作之前，右眼视力下降。在获得适当同意后对患者进行了检查。裂隙灯检查发现其右眼有环形角膜浸润伴上皮缺损。角膜刮片送去进行微生物学评估，结果显示革兰氏阴性杆菌，培养鉴定为产超广谱β-内酰胺酶菌落。患者对局部强化阿米卡星和妥布霉素反应良好。针对她的全身症状，儿科医生进行了全面的检查，其中血培养显示有 生长。因此，根据抗菌谱报告给予静脉抗生素治疗，患者康复。2周后，注意到她左眼有旁中心浸润，随后出现前葡萄膜炎。患者对局部使用类固醇及氨基糖苷类药物的疗程反应良好。4个月后，她右眼在发热前出现前葡萄膜炎复发。血液检查为阴性。因此，诊断为内源性感染继发的复发性葡萄膜炎，患者经短期局部类固醇治疗成功。该患者在过去6个月一直在接受随访，双眼最佳矫正视力维持在20/20，眼压正常，前房安静。这是第一份描述内源性角膜炎中环形浸润的临床报告，并强调为及时治疗进行全面检查。
