전신 및 면역질환자에서 백내장수술 후 Paecilomyces lilacinus 각막염 1예
Keratitis Caused by Paecilomyces lilacinus after Cataract Surgery in a Patient with Systemic and Autoimmune Disease
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 만성 전신 및 면역질환이 있는 환자에서 백내장수술 후 발생한 Paecilomyces lilacinus에 의한 진균각막염에서 약물 치료 및 전체층각막이식을 통해 치료한 1예를 보고하고자 한다. 증례요약: 72세 여자 환자가 백내장수술 시행 후 1달째 각막 봉합사 주변으로 각막부종과 기질혼탁이 동반되면서 시작된 좌안 통증 및 시력저하를 주소로 개인병원에서 2주간의 치료에도 호전이 없어 본원에 내원하였다. 환자는 고혈압, 고지혈증, C형 간염, 류마티스관절염의 전신 및 면역질환이 있었으며, 진균 및 세균성 각막염 의심하에 사용 중이던 국소 및 전신 스테로이드를 중단하고 amphotericin B 0.15%와 moxifloxacin 0.5% 점안을 시작하였다. 경과관찰 중 호전되지 않아 점안 항진균제를 natamycin 5%와 voriconazole 2%로 변경하고 경구로 voriconazole을 투여하였으나 전신 상태 악화와 더불어 각막융해가 일어나면서 각막이 천공되어 내원 6주째 공막편과 양막이식을 시행하였다. 내원 7주째 배양검사상 Paecilomyces lilacinus가 확진되었고 호전과 악화를 반복하다가 결국은 악화되어 내원 12주째 전체층각막이식을 시행하였으며 술 후 6개월까지 재발 소견 없이 안정적인 경과를 보였다. 결론: 만성 전신 및 면역질환이 있는 환자에서 백내장수술 후 발생한 Paecilomyces lilacinus 진균 각막염에서 지속적인 항진균제점안 및 전신적 투여에도 호전되지 않아 전체층각막이식을 시행하여 치료한 1예를 경험하였기에 보고하는 바이다.
Abstract
Purpose: To report a case of Paecilomyces lilacinus fungal keratitis after cataract surgery in a patient with chronic systemic and autoimmune disease who was treated with medical therapy and penetrating keratoplasty. Case summary: A 72-year-old female was referred for decreased visual acuity and ocular pain in the left eye. She underwent cataract surgery in the left eye 1 month earlier and was treated for 2 weeks for corneal edema and stromal infiltration around the corneal suture. She had a chronic systemic disease with hypertension, hyperlipidemia, hepatitis C and rheumatoid arthritis. Suspecting infectious keratitis, the patient was instructed to stop applying topical and systemic steroids and use topical amphotericin B (0.15%) and moxifloxacin (0.5%). However, without improvement, amphotericin B (0.15%) and moxifloxacin (0.5%) were changed to natamycin (5%) and topical voriconazole (2%) and systemic voriconazole was added. However, her systemic status deteriorated and corneal melting developed, scleral graft implantation and amniotic membrane implantation were performed to prevent corneal perforation 6 weeks after the initial visit. Paecilomyces lilacinus was identified in culture at 7 weeks and penetrating keratoplasty was performed 12 weeks after the initial visit. After penetrating keratoplasty, corneal status was stable for 6 months and no signs of recurrence were observed. Conclusions: In a patient with Paecilomyces lilacinus fungal keratitis and chronic systemic and autoimmune disease, penetrating keratoplasty showed good prognosis when the disease was refractory to topical and systemic antifungal agents.
참고문헌 (20)
- Srinivasan M, "Fungal keratitis", Curr Opin Ophthalmol, 15, pp.321~327 (2004)
- Abad JC., "Fungal keratitis", Int Ophthalmol Clin, 36, pp.1~15 (1996)
- Malecha MA., "Successful treatment of Paecilomyces lilacinus keratitis in a patient with a history of herpes simplex virus keratitis", Cornea, 25, pp.1240~1242 (2006)
- Jacobs H., "Interactions between nematophagous fungi and consequences for their potential as biological agents for the control of potato cystnematodes", Mycol Res, 107(Pt1), pp.47~56 (2003)
- Okhravi N., "Paecilomyces lilacinus endophthalmitis with secondary keratitis : a case report and literature review", Arch Ophthalmol, 115, pp.1320~1324 (1997)
- Chander J., "Prevalence of fungal corneal ulcers in northern India", Infection, 22, pp.207~209 (1994)
- Tanure MA., "Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania", Cornea, 19, pp.307~312 (2000)
- Hahn YH., "Epidemiology of fungal keratitis in Korea : a Multi-center Study", J Korean Ophthalmol Soc, 41, pp.1449~1508 (2000)
- Roumpos C., "Ecological studies on Paecilomyces lilacinus strain 251 and their importance for biocontrol of plant-parasitic nematodes and environmental risk assessment", pp.16~39 (2005), Cuvillier Verlag
- Hirst LW., "Non-traumatic mycotic keratitis", pp.391~395 (1992), Eye (Lond)
- Pastor FJ., "Clinical manifestations, treatment and outcomes of Paecilomyces lilacinus infections", Clin Microbiol Infect, 12, pp.948~960 (2006)
- Yuan X., "Pathogenesis and outcome of Paecilomyces keratitis", Am J Ophthalmol, 147, pp.691~696 (2009)
- Wu PC., "The successful medical treatment of a case of Paecilomyces lilacinus keratitis", Cornea, 29, pp.357~358 (2010)
- Monden Y., "Clinical experience treating Paecilomycs lilacinus keratitis in four patients", Clin Ophthalmol, 6, pp.949~953 (2012)
- McLintock CA., "Management of recurrent Paecilomyces lilacinus keratitis", Clin Exp Optom, 96, pp.343~345 (2013)
- 원재연, "전층각막이식 환자에서 발병한 Paecilomyces lilacinus 진균 각막염 1예", 대한안과학회지, 55(9), pp.1384~1387 (2014), 대한안과학회
- Bunya VY., "Topical and oral voriconazole in the treatment of fungal keratitis", Am J Ophthalmol, 143, pp.151~153 (2007)
- Byun DS., "A case of corneal ulcer caused by Paecilomyces in diabetic patient wearing soft contact lens", J Korean Ophthalmol Soc, 28, pp.667~671 (1987)
- 정새롬, "패실로마이세스 각막염: 국내 증례 보고 및 해외 문헌 고찰", 대한안과학회지, 57(3), pp.390~398 (2016), 대한안과학회
- Henry CR., "Delayed-onset endophthalmitis associated with corneal suture infections", J Ophthalmic Inflamm Infect, 3, pp.51~ (2013)