전층각막이식 환자에서 발병한 Paecilomyces lilacinus 진균 각막염 1예
A Case of Fungal Keratitis Caused by Paecilomyces lilacinus after Penetrating Keratoplasty
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목적: 전층각막이식술 후 발생한 Paecilomyces lilacinus에 의한 각막염 1예를 경험하여 이를 보고하고자 한다. 증례요약: 내원 7년 전 좌안 각막혼탁으로 좌안 전층각막이식술 후 이식 실패로 내원 2주 전 두 번째 좌안 전층각막이식술을 받은67세 환자가 내원 3일 전 시작된 통증, 이물감과 충혈을 주소로 본원에 내원하였다. 각막찰과표본을 얻어 균 도말 검사 및 배양검사를시행하였고 moxifloxacin, ceftazidime, amphotericin B를 점안하며 치료하였다. 균 배양검사상 Paecilomyces lilacinus가 배양되었으며 감수성 검사상 voriconazole에 감수성이 있어 voriconazole 점안액으로 치료하였으나 치료 2일째 각막천공이 발생하여 전층각막이식술 및 전방내 voriconazole 주사 후 치료되었다. 결론: P. lilacinus에 의한 각막염은 진행이 매우 빠르며 Amphotericin B 등의 기존 항진균제 점안과 정주 등의 치료에 잘 반응하지않고 각막천공이 발생하였다. P. lilacinus에 의한 각막염 발병 시 빠른 voriconazole 안약 사용 및 전방내 항진균제 주사 등의 보다적극적인 치료를 고려해야 한다.
Abstract
Purpose: To report a case of corneal ulcer caused by Paecilomyces lilacinus after penetrating keratoplasty. Case summary: A 67-year-old male with a history of penetrating keratoplasty in the left eye 7 years prior and re-penetrating keratoplastyin the left eye due to graft failure in June 2013, visited our clinic for ocular pain and conjunctival injection in the left eye3 days in duration. Corneal scrapings were performed for Gram and fungal stains and cultures. The patient was admitted to thehospital for hourly topical fortified ceftazidime and amphotericin B. Despite intensive topical therapy, no improvement wasobserved. Three days later, fungal culture confirmed Paecilomyces lilacinus and topical voriconazole was prepared from the intravenousformulation and was administered topically and intravenously. Despite medical therapy with voriconazole, perforationoccurred requiring a tectonic keratoplasty. Conclusions: Keratitis caused by Paecilomyces lilacinus is difficult to eradicate and refractory to amphotericin B. We suggestearly use of topical eyedrops, intracameral, and intravitreal injections of voriconazole may be an appropriate treatment for patientswith Paecilomyces lilacinus keratitis.
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