Shewanella Putrefaciens에 의한 감염각막염
Infectious Keratitis Caused by Shewanella Putrefaciens
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목적: 어업에 종사하는 환자에서 발생한 Shewanella putrefaciens (S. putrefaciens)에 의한 감염각막염 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 고혈압 외엔 기저질환이 없는 75세 남자가 좌안의 시력 저하 및 충혈이 2주간 호전없이 악화되어 내원하였다. 내원 당시 좌안의 최대교정시력은 안전수지였으며, 세극등검사상 좌안의 각막 중앙하부에 2.0 × 2.0 mm 크기의 상피결손을 동반한 기질침윤, 내피반 및 전방에 심한 염증과 1 mm 높이의 축농 소견을 보였다. 각막찰과표본을 얻어 세균배양검사를 시행하였다. 세균배양검사상 S. putrefaciens가 검출되었고, moxifloxacin과 ceftazidime 점안 항생제로 치료하였다. 치료 2개월째에 좌안의 최대교정시력은 0.4였으며, 임상적으로 각막에 경미한 기질 혼탁만을 남기고 치료되었다. 결론: 어업에 종사하는 환자에서 감염각막염이 발생했을 때, 흔하지는 않지만 원인균으로 S. putrefaciens를 고려해야 한다. 국내에서 보고된 적 없던 S. putrefaciens에 의한 감염각막염 1예를 경험하였기에 이를 보고하는 바이다.
Abstract
Purpose: We report a case of infectious keratitis caused by Shewanella putrefaciens in a patient after fishing. Case summary: A 75-year-old male with no underlying disease other than hypertension was admitted to our hospital because of decreased visual acuity and congestion in his left eye for 2 weeks. At the first ophthalmic examination, the best-corrected visual acuity (BCVA) of the left eye was counting fingers. Slit lamp examination showed stromal infiltrates with 2.0 × 2.0 mm corneal epithelial defects, endothelial inflammatory plaques and 1 mm height hypopyon with severe inflammation in the anterior chamber. Bacterial culture tests were performed by corneal scraping, which were positive for Shewanella putrefaciens, followed by treatment with moxifloxacin and ceftazidime topical antibiotics. After 2 months of treatment, the BCVA of the left eye improved to 0.4 and the corneal lesion clinically improved with residual mild stromal opacity. Conclusions: Shewanella putrefaciens should be considered as a causal pathogen of infectious keratitis in patients after fishing. We report a case of infectious keratitis caused by Shewanella putrefaciens, which has never previously been reported in the Republic of Korea.
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