Endogenous Bacterial Endophthalmitis as an Initial Manifestation of Infectious Endocarditis-A Case Report

以內因性眼內炎為起始表現之感染性心內膜炎―病例報告

林勇義(Yung-Yi Lin) ； 林信宏(Shin-Hong Lin) ； 楊長豪(Chang-Hao Yang)

《中華民國眼科醫學會雜誌》 43卷2期 (2004/06) Pp. 123-128

https://doi.org/10.30048/ACTASOS.200406.0008

摘要

內因性眼內炎的原因有很多，其中部分併有嚴重全身性疾病的病人，可能以內因性眼內炎為起始甚至是唯一的臨床表現；早期診斷、早期治療，是避免視力喪失甚至挽救生命的重要關鍵。本文報告一位四十五歲男性，因風濕性心臟病導致主動脈瓣狹窄，接受瓣膜置換手術，於術後四個月出現右眼眼內炎；其血液標本及玻璃體抽出物均未培養出病原體，心臟超音波顯示-0.4x0.5平方公分的二尖瓣贅疣，右眼眼底可見黃斑部膿腫、玻璃體混濁及多發性視網膜靜脈血栓。在感染性心內膜炎合併內因性眼內炎之診斷下，我們給予全身性萬古黴素治療以控制感染性心內膜炎，由於眼內炎持續惡化，我們施行經平坦部玻璃體切除術，之後又因局部之視網膜剝離，再度施行經平坦部玻璃體切除術及鞏膜扣環術。術後病人復原良好，可惜患者於術後四週死於急性心肌梗塞。

並列摘要

Purpose: We report a case of endogenous endophthalmitis as an initial manifestation of infectious endocarditis after aortic valve replacement.
Methods: Case report.
Results: The 45 year-old male patient was a victim of rheumatic heart disease with stenosis of aortic valve. He underwent open heart surgery with aortic valve replacement 4 months ago. He complained of blurred vision and mild eye pain of his right eye for 10 days before ophthalmic consultation. Cellular reaction was found in the anterior chamber. Vitreous opacity and submacular abscess was found in the posterior segment. Multiple septic emboli were also noted within retinal vessels. Bacterial vegetation was found on the mitral valve by transesophageal echocardiogram. Pars plana vitrectomy was performed and systemic vancomycin was given. His condition gradually improved. However, the visual outcome was still poor because of residual macular scar. The patient unfortunately expired one month after operation, due to acute myocardial infarction.
Conclusion: Infectious endocarditis should be highly suspected in the patients with cardiac valvular diseases who present with endogenous endophthalmitis.

並列關鍵字

Endogenous endophthalmitis ； Infectious endocarditis ； Subretinal abscess