结膜下脓肿:棘阿米巴角膜炎的罕见并发症。

IF 1.9 3区 医学 Q2 OPHTHALMOLOGY
Daniel Sibley, Laura de Benito Llopis
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引用次数: 0

摘要

目的:棘阿米巴角膜炎(AK)是一种影响角膜的罕见感染。免疫介导的硬皮角膜炎是一种证据充分的晚期并发症,通常需要全身免疫抑制。我们介绍了由棘阿米巴原虫直接入侵引起的结膜下脓肿的另一种临床表现,并提出了一种处理策略:本研究是在英国一家三级医疗中心进行的单个病例报告:一名 42 岁的隐形眼镜佩戴者曾戴隐形眼镜游泳,2 天后出现疼痛、发红和畏光症状。临床怀疑为 AK,后经共聚焦显微镜检查和培养证实为 AK。在使用 0.06% 聚六亚甲基双胍单药治疗四个月后,患者症状复发,并出现多个结膜下边缘脓肿,伴有巩膜炎。这些脓肿在诊室进行了引流,局部治疗改为 0.2% 洗必泰。抽出的脓液经培养呈棘阿米巴阳性。尽管脓肿最初有所好转,但在一个月内又复发了。再次进行了引流,并在治疗方案中增加了局部和口服伏立康唑。脓肿消退后,留下了一个硬肿症区域:尽管免疫介导的硬皮炎是 AK 更常见的并发症,但感染性硬皮炎也可能发生。需要正确识别巩膜炎的病因,以防止用全身免疫抑制剂误治感染性巩膜炎。经过反复引流和局部及全身使用伏立康唑,脓肿得以消退。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Limbal Subconjunctival Abscess: A Rare Complication of Acanthamoeba Keratitis.

Purpose: Acanthamoeba keratitis (AK) is a rare infection affecting the cornea. Immune-mediated sclerokeratitis is a well-documented late complication often requiring systemic immunosuppression. We present an alternative clinical presentation of subconjunctival abscesses caused by direct invasion of the Acanthamoeba and a proposed management strategy.

Methods: This study was a single case report performed at a tertiary care center in the United Kingdom.

Results: A 42-year-old contact lens wearer with a history of swimming in contact lenses presented with 2 days of pain, redness, and photophobia. There was clinical suspicion for AK that was later confirmed on confocal microscopy and cultures. Four months into treatment with polyhexamethylene biguanide 0.06% monotherapy, they experienced a relapse of symptoms and developed multiple subconjunctival limbal abscesses with associated scleritis. These were drained in the office, and topical treatment changed to chlorhexidine 0.2%. The aspirate was culture-positive Acanthamoeba . Despite initially improving, the abscess reoccurred within a month. Repeat drainage was performed, and topical and oral voriconazole was added to the treatment regime. The abscess resolved leaving an area of scleromalacia.

Conclusions: Despite immune-mediated sclerokeratitis being a more common complication of AK, infectious scleritis can also occur. Correct identification of the cause of scleritis is required to prevent mistreatment of infectious scleritis with systemic immunosuppression. The abscess resolved with repeated drainage and the use of topical and systemic voriconazole.

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来源期刊
Cornea
Cornea 医学-眼科学
CiteScore
5.20
自引率
10.70%
发文量
354
审稿时长
3-6 weeks
期刊介绍: For corneal specialists and for all general ophthalmologists with an interest in this exciting subspecialty, Cornea brings together the latest clinical and basic research on the cornea and the anterior segment of the eye. Each volume is peer-reviewed by Cornea''s board of world-renowned experts and fully indexed in archival format. Your subscription brings you the latest developments in your field and a growing library of valuable professional references. Sponsored by The Cornea Society which was founded as the Castroviejo Cornea Society in 1975.
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