레클레르시아 아데카르복시라타에 의한 각막궤양 1예
A Case of Corneal Ulcer Caused by Leclercia Adecarboxylata
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목적: 면역 정상인에서 발생한 레클레르시아 아데카르복시라타(Leclercia adecarboxylata)에 의한 각막궤양 1예를 경험하여 이를 보고하고자한다. 증례요약: 평소 건강하였던 43세 여자환자가 4일 전부터 발생한 우안 통증으로 개인 안과 방문, 각막 미란 소견으로 인공누액, 치료용 콘택트렌즈 착용 및 3일간 점안 항생제, 소염제 치료하였으나 호전 없고, 이차 감염 의심하에 의뢰되었다. 내원 시 각막 찰과 표본을 얻어 그람염색, 세균 및 진균 배양검사, 항생제 감수성 검사 등을 시행하였다. 세균배양 검사상 레클레르시아 아데카르복시라타가 동정되었고, 목시플록사신과 오플록사신 2주일 점안 치료 후 특이할 각막 내 흔적 없이 완전히 치료되었다. 결론: 면역 저하자에게 동시감염 또는 기회감염균으로 보고되어오던 레클레르시아 아데카르복시라타가 면역 정상인에서 병인균으로 검출된경우는 드물며, 안과 영역에서 단일 병인균으로 동정 보고된 적은 없었다. 따라서 면역 정상인의 각막 병변 치료 시 항생제에 잘 반응하는그람 음성 간균이 발견될 경우 상기 균의 가능성을 배제할 수 없겠다.
Abstract
Purpose: To report a case of corneal ulcer caused by Leclercia adecarboxylata in an immunocompetent patient. Case summary: A previously healthy 43-year-old female presented with right ocular pain and was referred to our clinic under theimpression of corneal abrasion and secondary infection. The patient was treated at a local clinic for 3 days using artificial tears,therapeutic contact lens, topical antibiotics, and anti-inflammatory eye drops but showed no improvement. Gram staining, bacterialand fungal cultures and antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth ofLeclercia adecarboxylata. The patient was treated with moxifloxacin and ofloxacin eye drops. After 2 weeks of treatment, the infectionresolved without remaining scars. Conclusions: Reportedly, Leclercia adecarboxylata affects humans only as an opportunistic pathogen or part of polymicrobial infections. However, in the present case, Leclercia adecarboxylata was isolated as a single pathogen in an immunocompetent patient which is the firstclinical report of this microorganism found in an ocular sample. Therefore, if antibiotic-susceptible gram-negative bacilli are found in opthalmologicsamples, the above bacteria should be considerd in the diagnosis.
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