이식편대숙주질환 환자에서 치료용콘택트렌즈 착용 후 발생한 하프니아 알베이에 의한 각막염 1예
Hafnia Alvei Keratitis after Using a Therapeutic Contact Lens in a Patient with Graft-Versus-Host Disease
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목적: 이식편대숙주질환 환자에서 생긴 Hafnia alvei에 의한 각막궤양의 사례를 보고하고자 한다. 증례요약: 급성림프구성백혈병으로 골수이식을 받은 이후 발생한 이식편대숙주반응으로 인해 심한 안구건조증과 실모양체각막염으로실모양체를 제거한 후 치료용콘택트렌즈를 착용하고 예방적으로 moxifloxacin을 점안하던 환자가 개인적인 사정으로 항생제를 7일간점안하지 못하였다. 이후 각막 주변부 11시 방향에 상피결손과 기질침윤을 동반한 각막궤양이 발생하여, 콘택트렌즈 및 각막찰과물의균배양 및 균동정검사를 시행하였다. 균배양검사에서 Hafnia alvei가 배양되었고 위장관을 비롯한 다른 전신상태에서는 특별한 이상소견은 보이지 않았다. 항생제감수성검사에서 감수성이 있다고 나타난 gatifloxacin을 점안한 이후 병변은 경미한 혼탁만을 남기고치료되었다. 결론: Hafnia alvei는 사람에게는 드물게 감염을 일으키는데 주로 기회감염의 형태로 호흡기계나 소화기계에 감염을 일으킨다. 이식편대숙주반응과 연관된 면역억제환자, 특히 전신적인 면역억제 치료를 받는 환자에서 각막염이 발생한 경우 Hafnia alvei와 같은 드문균에 의한 기회감염도 고려해야 하겠다.
Abstract
Purpose: To report a case of bacterial keratitis caused by Hafnia alvei after using a contact lens in a patient with graft-versus-host disease. Case summary: A 47-year-old male patient presented with a corneal ulcer. The patient had been wearing a therapeutic contact lens for a month because of severe dry eye syndrome and filament removal due to filamentary keratitis. The patient had been taking moxifloxacin to prevent infection, but had not for the previous 7 days. The corneal ulcer occurred at the 11o’clock direction in the peripheral cornea accompanied by corneal epithelial defect and stromal infiltration. The corneal scraping and culture yielded Hafnia alvei, which is susceptible to ceftazidime, levofloxacin and moxifloxacin. There was no systemic signs or symptoms to suspect systemic infection. After treatment with a topical antibiotic agent, the patient’s eye condition improved with only mild corneal opacity remaining. Conclusions: Hafnia alvei infection rarely occurs in humans but should be considered as a potential causal pathogen in immunosuppressed patients.
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