백내장수술 후 발생한 스트렙토코커스 디스갈락티아에 의한 안내염 1예
A Case of Streptococcus dysgalactiae Endophthalmitis after Cataract Surgery
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목적: 국내에서 보고된 적이 없는 백내장수술 후 발생한 Streptococcus dysgalactiae에 의한 안내염 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 65세 남자 환자가 좌안 백내장수술을 받은 후 발생한 안내염으로 본원으로 전원하였다. 내원 당시 좌안 시력은 광각인지였으며 전방 및 유리체강내 염증이 심하여 좌안 유리체절제술, 인공수정체 제거술, 유리체강내 항생제 및 스테로이드 주입술을 시행하고 유리체액과 전방수로 배양검사를 시행하였다. 술 중 시행한 유리체 배양검사에서 Streptococcus dysgalactiae가 동정되었다. 하지만 술 후에도 전방 및 유리체강내 염증이 점점 심해져 술 후 4일째 전방세척술, 유리체강내 항생제 주입술을 시행하였다. 술 후 25일째 퇴원하였으며 퇴원 당시에도 각막 윤부 신생혈관, 각막 위축, 각막 부종, 침윤, 전방 축농이 지속되었다. 외래 경과 관찰 중 시력은 광각인지 불가로 진행하였으며 안구위축이 진행하는소견을 보였다. 결론: Streptococcus dysgalactiae에 의한 안내염은 매우 드문 질환으로 국내에서 보고된 적이 없으며, 저자들은 적극적인 치료에도 불구하고 예후가 좋지 않았던 안내염 1예를 경험하였기에 이를 보고하는 바이다.
Abstract
Purpose: To report the first case of endophthalmitis due to Streptococcus dysgalactiae after phacoemulsification and posterior chamber intraocular lens implantation in the Republic of Korea. Case summary: A 65-year-old male was transferred because of endophthalmitis following cataract surgery. His initial visual acuity was light perception. Because inflammation of the anterior chamber and vitreous cavity progressed rapidly, we performed total pars planar vitrectomy and intraocular lens extraction in addition to administering intravitreal antibiotics and intravitreal dexamethasone injections. Streptococcus dysgalactiae was identified in samples cultured from the vitreous and anterior chamber fluid. Four days after surgery, we washed the anterior chamber and intravitreal antibiotics were again injected because of increased inflammation of the anterior chamber and vitreous. The patient was discharged 25 days after surgery but corneal neovascularization, contraction, edema, infiltration, and hypopyon remained. Visual acuity progressed to no light perception and there was shrinkage of the globe. Conclusions: Endophthalmitis due to Streptococcus dysgalactiae is very rare. We report the first case of endophthalmitis caused by Streptococcus dysgalactiae in the Republic of Korea. The prognosis for recovery was poor despite aggressive treatment.
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