방사상각막신경염의 임상양상을 보인 세라티아 마르세센스 각막염 1예
A Case of Serratia Marcescens Keratitis Presenting as Radial Keratoneuritis
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목적: 콘택트렌즈 착용 후 발생한 방사상각막신경염의 임상양상을 보인 세라티아 마르세센스 각막염을 경험하였기에 보고하고자 한다. 증례요약: 15세 여자 환자가 내원 2주일 전부터 시작된 좌안의 시력저하 및 통증을 주소로 내원하였다. 환자는 3년 전부터 미용렌즈와각막굴절교정학 콘택트렌즈를 착용하였으며 불규칙적으로 렌즈 관리를 하고 있었다. 전안부 검사상 각막중심부에 원형형태의 각막상피결손과 기질침윤 및 방사상각막신경염 소견이 관찰되었다. 각막찰과, 콘택트렌즈 및 렌즈 보존액에서 배양검사를 실시한 후, 가시아메바각막염 의심하에, chlorhexidine 0.02% (Sigma Co., USA)와 moxifloxacin 0.5% (VigamoxⓇ, Alcon, TX, USA)를 1시간 간격으로점안하고 itraconazole 200 mg (SporaoneⓇ, LG, Seoul, Korea)을 3일간 경구로 투여하였으나 병변의 호전은 없었다. 배양검사상Serratia marcescens가 동정되어 항생제 감수성 배양 결과에 따라 chlorhexidine 0.02%는 중지하고 ceftazidime (TazimeⓇ, Hanmi,Seoul, Korea)을 정맥 주입하며 ceftazidime (50 mg/mL)안약과 moxifloxacin 0.5%를 점안하자 각막염은 호전되었으며, 치료 6개월후 최대 교정시력은 20/20이었다. 결론: 콘택트렌즈 착용 후 가시아메바각막염과 유사한 방사상각막신경염의 임상양상을 보이는 각막염의 경우 세라티아 마르세센스원인균일 수 있으며, 진단을 위해 철저한 배양검사가 필요할 것으로 생각한다.
Abstract
Purpose: To report a case of Serratia marcescens keratitis presenting as radial keratoneuritis. Case summary: A 15-year-old female who wore cosmetic and orthokeratology contact lenses but performed inadequate lenscare visited our clinic with severe pain and visual disturbance in her left eye. On slit lamp examination, central corneal epithelialdefect and stromal infiltration with radial keratoneuritis were observed. Based on clinical findings and past history,Acanthamoeba keratitis was highly suspected. The patient was treated with topical chlorhexidine 0.02% (Sigma-Aldrich Co.,MO, USA) and moxifloxacin 0.5% (Vigamox®, Alcon, TX, USA) per hour with 200 mg of oral itraconazol (Sporaone®, LG, Seoul,Korea) once a day. Symptoms and corneal lesions did not improve after three days. After Serratia marsenscens was isolatedfrom her contact lenses and solution, topical chlorhexidine 0.02% was discontinued, and intravenous ceftazidime (Tazime®,Hanmi, Seoul, Korea) and fortified ceftazidime (50 mg/mL) eye drop was added. The corneal lesion dramatically improved, andafter six months of follow-up, best-corrected visual acuity was 20/20 in the affected eye. Conclusions: Radial keratoneuritis can present not only in Acanthamoeba keratitis, but also in Serratia marsenscens keratitis. Confirmation of the isolated organism is useful when treating radial keratoneuritis.
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