Acute Total Keratolysis of Trichophyton Fungal Keratitis-Case Report

髮癬菌屬黴菌性角膜炎導致之急性全角膜溶蝕：病例報告

陳達慶(Ta-Ching Chen) ； 江怡慧(Yi-Hui Chiang) ； 葉伯廷(Po-Ting Yeh) ； 胡芳蓉(Fung-Rong Hu) ； 陳偉勵(Wei-Li Chen)

《中華民國眼科醫學會雜誌》 48卷1期 (2009/03) Pp. 74-80

https://doi.org/10.30048/ACTASOS.200903.0011

摘要

目的：本文報告一例少見之髮癬菌屬黴菌感染所導致之角膜炎併發急性全角膜溶蝕現象。
方法：介入性病例報告
結果：一位25歲女性一個月來有右眼疼痛，畏光，視力減退之現象。就診時可見中央角膜部份出現大片緻密的羽絨狀浸潤及角膜溶蝕現象。其角膜採樣經黴菌培養後認定為髮癬菌屬黴菌感染。在局部納他黴素眼藥水及口服伊曲康哇治療下，病情持續惡化至全面性角膜溶蝕併發虹膜及水晶體前移。我們採取緊急甘德森結膜皮瓣移植手術治療，成功控制了黴菌感染；並佐以暫時性眼瞼縫合術以預防眼球破裂。術後三個月的門診追蹤，結膜皮瓣完整並且無感染跡象。
結論：髮癬菌屬黴菌性角膜炎是一種少見的黴菌感染，這類病人常常表現出急性的角膜溶蝕。手術治療常用於藥物無法有效控制之病例。而當全層角膜移植有實行上困難時，緊急結膜皮瓣移植也可為一有效之治療方法。

並列摘要

Objectives: To report a case of Trichophyton fungal keratitis with acute total keratolysis.
Method: Interventional case report.
Results: The 25-year-old woman has been suffering from decreased vision, pain, and photophobia in her right eye for 1 month. Slit lamp biomicroscopy revealed dense, feathery-like infiltrate in the central cornea with mild melting. Ring-shaped infiltrate was also noted in peripheral cornea. Gram's stain of the corneal scraping revealed filamentary hyphaes. Cultures of the corneal scraping revealed Trichophyton spp. Despite medication of topical Natamycin and oral Itraconazole, total melting of the whole cornea with anterior bulging out of lens/iris was found. Emergent transplantation of conjunctival flap and temporary tarsorrhaphy were performed to prevent loss of intraocular contents. The conjunctival flap remained in place three months after surgery. Fungal ulcer was considered to be cured after the operation.
Conclusions: Acute total keratolysis can be found in patient with Trichophyton fungal keratolysis. The aggressive nature of the infection was difficult to treat by medical treatment. Counjunctival flaps offered a useful emergent therapeutic modality when therapeutic keratoplasty can not be performed.

並列關鍵字

fungal keratitis ； Trichophyton ； keratolysis