Klebsiella ozaenae에 의한 내인성 안내염
Endogenous Endophthalmitis Due to Klebsiella ozaenae
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목적: Klebsiella ozaenae는 주로 구강과 비인강의 상재균으로 만성 위축성 비염의 원인으로 알려져 왔다. 안내염의 원인균으로 드문 Klebsiella ozaenae에 의한 내인성 안내염의 증례를 경험하였기에 보고하고자 한다. 증례요약: 간세포암으로 항암화학요법 치료 중이던 61세 남자 환자가 2일 전부터 발생한 좌안의 시력 저하와 통증으로 의뢰되었다. 시력은 안전 수지 10 cm, 안압은 29 mmHg였으며, 공막부분파열과 맥락막 노출 소견과 함께 초음파 검사에서 망막하 농양 소견을 보였다. 배뇨 시 통증 및 빈뇨 증상과 함께 소변검사에서 백혈구뇨 및 세균뇨 소견을 보여 요로감염에 의한 내인성 안내염을 의심하였다. 유리체강내 항생제주입술 및 전신항생제 치료를 하였음에도 불구하고 4일째 시력은 광각무 상태로 저하되었다. 통증이 심해지고 안압은 조절되지 않아 이후 안구 적출술이 시행되었으며 안구 내 농 배양 검사에서 Klebsiella ozaenae가 배양되었다. 결론: Klebsiella ozaenae는 안내염의 드문 원인균으로 염증의 진행 속도가 빠르고 예후가 좋지 않았다. 또한 내인성 안내염의 원인으로 화농성 간농양 이외에 요로감염도 염두에 두어야 한다.
Abstract
Purpose: To report a case of endogenous endophthalmitis due to Klebsiella ozaenae, which is a rare causative organism of endophthalmitis. Case summary: A 61-year-old male who was undergoing chemotherapy for hepatocellular carcinoma complained of sudden visual loss and ocular pain in his left eye for 2 days. On the first examination, the patient’s visual acuity was counting fingers at 10 cm and the intraocular pressure was elevated to 29 mm Hg. Partial scleral rupture and choroidal prolapse were observed. Subretinal abscess was detected with increased echogenicity using ultrasonography. The patient complained of burning sensation on voiding and urinary frequency; subsequent urinalysis showed pyuria and bacteriuria. Intravitreal and systemic antibiotics were administered under the impression of endogenous endophthalmitis caused by urinary tract infection. Despite treatment, visual acuity decreased to no light perception in 4 days and intraocular pressure and pain was uncontrollable. Enucleation was performed and pus culture from the eye during surgery revealed Klebsiella ozaenae. Conclusions: Klebsiella ozaenae is a rare causative organism of endophthalmitis and shows a rapid progress and poor prognosis. Endogenous endophthalmitis must be highly suspected in patients with urinary tract infection as well as pyogenic liver abscess.
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