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Corneal Ring Infiltrate in a Patient with Cytomegalovirus Endotheliitis: A Case Report
角膜間質環狀浸潤表現於一例巨細胞病毒角膜內皮細胞炎：個案報告
摘要
目的：報告一位表現角膜間質環狀浸潤的巨細胞病毒角膜內皮細胞炎病例。方法：病例報告。結果：一位37歲男性，於過去六個月，雙眼多次反覆發作發炎性背光眼。他曾在十年前被診斷為青光跟隨狀體危象症候群。裂隙燈下鏡檢發現雙眼界線分明的角膜內皮細胞炎及許多細小角膜後沉積物。眼壓測量雙眼皆升高。將前房液取樣進行病毒去氧核糖核酸(DNA)聚合酶(PCR)分析，巨細胞病毒呈陽性反應，而單純泡疹病毒第一型，單純疱疹病毒第二型，及帶狀描疹病毒皆為陰性反應。給予gancyclovir與prednisolone眼藥水治療後，雙眼角膜內皮細胞炎緩解，眼壓也獲得控制。然而，在治療期間，每當嘗試減量並且停止使用gancyclovir與prednisolone眼藥水治療時，雙眼角膜內皮細胞炎便迅速復發。此外，更觀察到左眼有明顯的雙環狀角膜間質浸潤，以過去的角膜內皮細胞炎為中心，呈同心圓樣式的排列。此雙環狀角膜間質浸潤與角膜後沉積物，當重新用上gancyclovir與prednisolone眼藥水治療後，便逐漸的消失。後續使用gancyclovir與prednisolone眼藥水治療的12的月追蹤期間，並無任何復發。結論：角膜間質浸潤的表現，在巨細胞病毒角膜內皮細胞炎中，尚未有臨床報告。從本病例推論，巨細胞病毒所引起的角膜內皮細胞炎，也能夠引起類似單純疱疹病毒免疫壞的抗原抗體的免疫反應。
關鍵字
無資料並列摘要
Purpose: To report the observation of corneal ring infiltrate in a patient with cytomegalovirus (CMV) corneal endotheliitis. Methods: Single interventional case report. Results: A 37-year-old man presented with a 6-month history of multiple recurrent attacks of inflammatory glaucoma in both eyes. A diagnosis of Posner-Schlossman syndrome was made 10 years previously. Slit-lamp examination showed a well-defined patch of endotheliitis and some keratic precipitates in both corneas. The intraocular pressure was elevated in both eyes. Aqueous humor sampling for viral DNA detection by polymerase chain reaction was positive for CMV and negative for herpes simplex virus (HSV) type 1, HSV type 2, and varicella zoster virus. After the patient used topical ganciclovir and prednisolone, the endotheliitis resolved and the intraocular pressure was under control. However, the anterior chamber inflammation recurred in both eyes whenever the topical eye drops were discontinued. Moreover, a prominent double ring stromal infiltrate centering on the previous endotheliltis area was observed in the left cornea. The ring infiltrate and new keratic precipitates disappeared progressively after the topical eye drops were reapplied. At the 12-month follow-up examination, no recurrence of ring infiltrate was noted after use of topical ganciclovir and prednisolone eye drops. Conclusion: Corneal ring infiltrate has not been reported previously in CMV endotheliitis. This finding suggests that CMV leading to corneal endotheliitis can also induce the antigen-antibody immunologic reaction analogous to that of HSV immune ring infiltrate.
延伸閱讀
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