Mycotic Keratitis Caused by Bipolaris Species - Report of Two Cases

Bipolaris黴菌性角膜炎－病例報告

黃福進(Fu-Chin Huang) ； 黃聖鵬(Shen-Terng Huang) ； 曾順輝(Sung-Huei Tseng)

《慈濟醫學雜誌》 10卷4期 (1998/12) Pp. 345-349

https://doi.org/10.6440/TZUCMJ.199812.0345

摘要

Bipolaris菌通常無致病性，唯有在宿主抵抗力減弱時才較容易造成感染。但若侵犯角膜造成潰瘍時，宿主大多為身體正常之患者。本文報告兩例Bipolaris菌引起之角膜炎病例。
病例一是64歲男性，為一肝癌及肝硬化併有免疫功能下降之患者。右眼病灶位於週邊角膜表面，並呈現塊狀突起，在經抗黴菌藥物治療無效後，施行清創，並獲得初步症狀改善。不幸在治療期間併發Pseudomonas菌感染，在合併使用抗黴菌及抗細菌藥物治療後，獲得滿意之病灶癒合。病例二是41歲女性，患有顏面神經麻痺及右眼瞼閉合不良。右眼角膜病灶呈潰瘍併有前房蓄膿，在經兩週藥物治療無效後，病人接受角膜移植治療。在術後八個月確定未再復發，並且視力回復至20/200。

關鍵字

黴菌 ； 角膜潰瘍 ； 角膜炎

並列摘要

Nonocular Bipolaris infection usually occurs in immunocompromised patients. Corneal infections with Bipolaris have rarely been reported. A review of the literature shows that corneal infections caused by Bipolaris specties occurred mainly in immunocompetent hosts. Here, we report two cases of Bipolaris keratitis refractory to medical treatment. Case 1, a 64-year-old man, had liver cirrhosis and hepatoma associated with systemic immunocompromization. The keratitis presented with an elevated plaque in the peripheral cornea. The lesion responded poorly to antifungal agents. Initially, after vigorous debridement of the plaque, there was some clinical improvement. However, the patient also had a superimposed pseudomonal infection. He was treated with antifungal and antibacterial medication, and the lesion responded successfully with the sequela of corneal leukoma. Case 2, a 41-year-old female, had facial palsy with lagophthalmos. A central corneal ulcer with necrotizing pattern and hypopyon was noted. Despite intensive treatment with antifungal agents for 2 weeks, there was no evidence of improvement. A therapeutic penetrating keratoplasty was done due to uncontrollable infection. Following these treatment modalities, she preserved ocular integrity and had useful vision.

並列關鍵字

Bipolaris species ； corneal ulcer ； keratitis