Endogenous Endophthalmitis as a Primary Focus of Klebsiella Pneumoniae Infection-A Case Report

以內因性眼內炎為原發病灶的克列伯氏肺炎桿菌感染－病例報告

鄭成國(Cheng-Kuo Cheng) ； 王廷文(Ting-Wen Wang) ； 李東昇(Tong-Sheng Lee)

《中華民國眼科醫學會雜誌》 43卷1期 (2004/03) Pp. 54-61

https://doi.org/10.30048/ACTASOS.200403.0008

摘要

目的：報告一名以內因性眼內炎為原發病灶的克列伯氏肺炎桿菌感染之糖尿病病例。
方法：病例報告。
結果：一位75歲罹患糖尿病的女性患者，突然在一天內左眼視力模糊。最佳矯正視力為1/60。經眼部檢查有中等程度的前房細胞反應及嚴重的黃白色玻璃體混濁。在內因性眼內炎的診斷下，施行睫狀體坦部玻璃體切除及抗生素玻璃體內注射。術中發現視網膜廣泛散佈有白色的小菌落，動脈明顯的空鞘化及在鼻側下方有一明顯局限性的黃色視網膜下膿瘍。玻璃體切除術後，在視網膜下膿瘍處發生裂孔性視網膜剝離及增殖性玻璃體視網膜病變，於是再次施行部分視網膜切除及矽質油填塞術。玻璃體細菌培養長出克列伯氏肺炎桿菌。系統性全身檢查，包括－67全身掃描，並沒有發現任何其它的感染源。術後追蹤六個月，視網膜成功復位，最佳矯正視力為辨別指數。
結論：內因性克列伯氏肺炎桿菌性眼內炎的臨床表現可以只發生在眼睛本身。因此，正確的診斷仰賴高度的警覺與對疾病的熟悉。為能保存最好的預後視力，儘早手術及抗生素玻璃體內和靜脈注射治療是相當重要的。

並列摘要

Purpose: To report a case of endogenous Klebsiella pneumoniae endophthalmitis as a primary infectious focus in a diabetic patient.
Methods: Case report.
Results: A 75-year-old diabetic woman had suffered from abrupt visual loss in her left eye for one day without any systemic symptoms. The best-corrected visual acuity was 1/60 and ocular examinations revealed moderate anterior cells and a dense yellowish white vitreal opacity. Under the impression of endogenous endophthalmitis, pars plana vitrectomy and intravitreal injections of antibiotics were performed. Diffue white fluffy nodules in the retina, markedly sheathing arteries and a well-demarcated yellowish subretinal abscess in the inferionasal fundus were found at the time of surgery. This subretinal abscess resulted in a retinal break and proliferative vitreoretinopathy requiring additional operations including retinectomy and silicon oil tamponade. The vitreous culture yielded Klebsiella pneumonia. Despite repeated and thorough systemic check-up including Gallium-67 whole body scan, no other infectious origin was found. Retinal reattachment could be achieved but the best-corrected visual acuity was only finger-counting 6 months postoperatively.
Conclusion: Endogenous Klebsiella pneumoniae endophthalmitis could present as a solitary focus that may demand a high index of suspension to diagnose. Early surgical intervention with intravitreal and parenteral antibiotics treatment may be very important to obtain maximal visual potential in this aggressive disease.

並列關鍵字

endogenous endophthalmitis ； Klebsiella pneumoniae ； subretinal abscess ； pars plana vitrectomy