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Orbital Apex Syndrome and Central Retinal Artery Occlusion Caused by Mucormycosis-Case Report
白黴菌感染併發眼窩尖端症候群及中心視網膜動脈阻塞
摘要
目的：報告一個白黴菌感染病例之眼部表現。 方法：病例報告及螢光眼底血管攝影嶺現與病理組織證實。 結果：一位患有糖尿病及慢性鼻竇炎的65歲男性，主訴持續兩天右眼腫痛以及視力模糊，鼻竇電腦斷層顯示鼻竇炎，疑似侵襲性的黴菌鼻竇炎，於是緊急施行鼻腔內視鏡清創手術，根據術中鼻腔內大量黑痂的發現，臨床上診斷為白黴菌感染並開始給予靜脈及局部的amphotericin-B治療。眼部表現有中心視網膜動脈阻塞與六條眼外肌幾近完全麻痺，對側眼睛視力後來也受到影響，病人情況持續惡化，9天後死於敗血症與呼吸衰竭。 結論：我們報告一個致死性白黴菌感染的病例報告，眼部表現包括中心視網膜動脈阻塞與眼窩尖端症候群，在碰到患有糖尿病的病人發生疑似眼部蜂窩性組織炎時，應該提高警覺懷疑此致命性感染的可能。
關鍵字
無資料並列摘要
Purpose: To report the ocular manifestations of a case of rhino-orbital mucormycosis. Method: Case report, fluorescein angiography and histopathology findings Case report: A 65-year-old male with diabetic mellitus complained of painful periocular swelling and blurred vision in the right eye for two days. Best-corrected visual acuity (BCVA) was CF/30cm. Computed tomography revealed sinusitis. Invasive fungal sinusitis was impressed. Emergent endoscopic sinus surgery revealed diffuse necrotic black escar and mucormycosis was diagnosed. Central retinal artery occlusion and almost complete loss of motility of all extraocular muscles of right eye developed later. Despite the treatments of systemic and focal amphotericin-B, periorbital erythematous swelling and decreased vision of the fellow eye developed. Nine days after admission the patient expired due to septic shock and respiratory failure. Conclusion: We report a case of fatal rhino-orbital mucormycosis with the ophthalmic manifestations of central retinal artery occlusion and orbital apex syndrome. When facing orbital cellulitis in a diabetic patient, we should be alert to this fatal disease.
延伸閱讀
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