백내장 수술 후 서로 다른 임상 양상을 보인 스테노트로포모나스 말토필리아 안내염 2예
Two Different Cases of Stenotrophomonas Maltophilia Endophthalmitis after Cataract Surgery
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목적: 백내장 술 후 발생한 Stenotrophomonas maltophilia에 의한 안내염의 서로 다른 임상경과를 경험하여 보고하고자 한다. 증례요약: 당뇨병 등의 과거력이 있는 73세 남자가 백내장 술 후 2주 뒤 심한 안구 통증으로 내원하여 안내염으로 진단받고 유리체절제술을 시행 받았다. 방수, 유리체강 내 흡인물 세균배양검사에서 S. maltophilia가 검출되었다. 술 후 1개월 뒤 시력은 20/20으로 호전되었으며 재발은 없었다. 특이 병력 없는 61세 여자가 동일 병원에서 백내장 술 후 1개월 뒤 포도막염 의증으로 의뢰되어 시행한 방수세균배양검사에서 같은 균이 배양되었고 3주 뒤 Aspergillus fumigatus가 검출되어 국소 항진균제 치료도 함께 시행하였다. 3개월뒤 시력은 20/25까지 호전되었다. 결론: S. maltophilia는 주로 기회감염균으로 알려져 있으나 최근 오염된 수술기구 및 세척액을 통해 유입, 백내장 술 후 발생한 안내염의 원인균으로 보고되고 있다. 본 증례들은 동일 병원에서 백내장 수술 후 발생한 경우로 증례 간의 임상양상의 차이를 보여 기존의보고들과 비교, 고찰하였다.
Abstract
Purpose: To report 2 different cases of postoperative endophthalmitis caused by Stenotrophomonas maltophilia after cataract surgery. Case summary: A 73-year-old male with diabetes mellitus developed severe pain in the right eye 2 weeks after cataract surgery. The patient was hospitalized with a diagnosis of infectious endophthalmitis, and vitrectomy was performed. Cultures of aqueous humor and vitreous aspirate revealed S. maltophilia. On day 30 after vitrectomy, his visual acuity had improved to 20/20 and there were no recurrences. A 61-year-old female with no significant past medical history was referred for uveitis or delayed onset endophthalmitis 30 days after cataract surgery. An anterior chamber tapping and cultures were performed. S. maltophilia and Aspergillus fumigatus were isolated. The patient received antibiotics and antifungal agents and her visual acuity improved to 20/25. Conclusions: S. maltophilia has been considered a life-threatening systemic opportunistic infection; however, the organism has recently been reported as an exogenous pathogen of endophthalmitis following cataract surgery. Herein, 2 different cases of S. maltophilia endophthalmitis after cataract surgery are presented and compared with previous case reports.
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