눈물주머니코안연결술 및 실리콘관삽입술 후 발생한 형광균 감염 1예
A Case of Pseudomonas fluorescens Infection after Dacryocystorhinostomy and Silicone Tube Intubation
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목적: 눈물주머니코안연결술 및 실리콘관삽입술 후 발생한 Pseudomonas fluorescens 감염 1예를 보고하고자 한다. 증례요약: 72세 여자환자가 눈물흘림, 눈구석의 발적을 주소로 내원하였다. 환자는 10개월 전 코눈물관폐쇄로 코경유 눈물주머니코안연결술 및 실리콘관삽입술을 시행 받았고, 술후 6개월째 골공의 폐쇄가 발생하여 골공 확장술 및 실리콘관교환술을 시행 받은 후 비강스테로이드 분무제를 사용 중이었다. 세극등검사에서 우안 안쪽 눈구석의 결막 충혈, 상, 하 눈물점의 발적과 부종이 관찰되었다. 실리콘관 제거 후 균배양검사에서 Pseudomonas fluorescens가 동정되었고 항생제 감수성 결과에 따라 0.3% gatifloxacin을 1일 4회 점안,methylol cephalexin lysinate 1000 mg을 1일 3회 경구 투약하였고 비강스테로이드 분무제는 중단하였다. 2주간 치료 후 환자의 증상은 호전되었고 염증소견은 보이지 않았다. 결론: Pseudomonas fluorescens 에 의한 눈물소관염이 비강스테로이드제를 투여하던 정상면역환자에서 발생하였고 항생제를 이용하여 적절히 치료하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Purpose: To report a case of Pseudomonas fluorescens infection following endoscopic dacryocystorhinostomy and silicone tube intubation in a healthy patient who was using steroid nasal spray. In addition, a literature review is conducted. Case summary: A 72-year-old female patient came to our clinic with tearing and hyperemia in the right eye. Ten months prior, she had undergone endoscopic dacryocystorhinostomy and silicone tube intubation due to nasolacrimal duct obstruction in the right eye. Six months after the first operation, dacryocystorhinostomy revision with silicone tube exchange was performed due to obstruction of the nasal bony orifice. In addition, the patient was using a steroid nasal spray. On slit lamp examination, conjunctival injection, marked inflammation and punctal edema around the tube were observed. The silicone tube was removed and the tube cultured. Pseudomonas fluorescens was isolated from the tube contents. The patients was treated with topical 0.3% gatifloxacin 4 times a day, methylol cephalexin lysinate 1000 mg 3 times a day and the nasal spray was discontinued. Two weeks later, all symptoms were resolved after treatment with antibiotic treatment. Conclusions: A case of Pseudomonas fluorescens canaliculitis which occurred in healthy patient who was using steroid nasal spray is presented with a literature review. Pseudomonas fluorescens canaliculitis can be treated by using proper antibiotics.
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