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Infective Endocarditis Presenting as Sudden Unilateral Visual Loss-A Case Report
以突然單眼視力喪失為初始表徵的成染性心內膜炎之病例報告
摘要
目的：報告一位感染性心內膜炎的病例以單眼視力喪失為她的初始表徵。 方法：病例報告 結果：一位54歲女性因為早上起床後，突然發現右眼視力喪失而就診，當時右眼視力為於眼前10公分可辨手動，左眼視力為20/20。眼底檢查發現右眼中心性視網膜動脈阻塞合併缺血性視神經病變及羅氏斑點(Roth's spot)。左眼眼底可見視網膜分支動脈阻塞。因為眼部多處動脈阻塞，我們懷疑可能有全身系統性血栓，因此轉至心臟內科作詳細檢查。 結果心臟超音波發現二尖瓣有贅生物，而且兩套血液培養皆呈陽性，因此診斷為感染性心內膜炎。病人接受四個星期靜脈抗生素治療後，順利治癒，不需接受瓣膜移植手術。 結論：我們建議，每位視網膜動脈阻塞的病人都應該做系統性的檢查來偵測是否有需要治療的全身性的疾病。如果這位感染性心內膜炎病患並未及時轉診治療，可能會演變出更多全身性的併發症，甚至造成死亡的情形。
關鍵字
無資料並列摘要
Purpose: To report a case of infective endocarditis with a primary presentation of sudden unilateral painless visual loss. Method: a case report Result: This 54-year-old woman presented with sudden painless visual loss in her right eye when she woke up in the early morning. The visual acuity were hand motion/10 cm in the right eye and 20/20 in the left eye. Funduscopic findings were central retinal artery occlusion combined with anterior ischemic optic neuropathy and Roth’s spot in her right eye. Branch retinal artery occlusion was also noted in her left eye. We performed a detailed cardiac examination because of the multiple arterial occlusions of both eyes leading to a tentative diagnosis of systemic embolization. Vegetation at the mitral valve detected by transthoracic echocardiogram and two positive blood cultures fulfilled the diagnosis of infective endocarditis. This patient improved clinically after intravenous antibiotics for 4 weeks without immediate need of mitral valve replacement. But her visual acuity remained hand motion/10 cm in the right eye without improvement. Conclusion: We recommended performing systemic evaluations for all patients with acute retinal artery obstruction to detect if there is any clinical significant systemic disease. In this case, if we had not been alert and promptly referred the patient to a cardiologist to initiate treatment, other systemic complications even mortality might be happened.
延伸閱讀
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