Combined Endogenous Endophthalmitis and Meningitis Secondary to Infectious Endocarditis - A Case Report

感染性心內膜炎併發內因性眼內炎及腦膜炎－病例報告

林俊佑(Jiun-Yo Lin) ； 龔雅欣(Ya-Hsin Kung) ； 洪美情(May-Ching Hong) ； 許淑娟(Shwu-Jiuan Sheu)

《中華民國眼科醫學會雜誌》 51卷1期 (2012/03) Pp. 84-89

https://doi.org/10.30048/ACTASOS.201203.0012

摘要

目的：報告一個病例：由肺炎鏈球菌所引發之心內膜炎並導致腦膜炎及內因性眼內炎。方法：病例報告。結果：一位42歲的女性主訴右眼疼痛性腫脹併意識混亂已有兩天的時間。身體檢查顯示了細菌性腦膜炎及心內膜炎。眼部檢查顯示了右眼視力無光感，睫狀充血，結膜下膿瘍，角膜水腫，及前房的滲出物及纖維蛋白。血液及腰椎穿刺顯示了細菌感染。心臟超音波發現主動脈瓣膜贅生物。診斷為心內膜炎相關之腦膜炎及內因性眼內炎。使用玻璃體內注射vancomycin及ceftazidime加上靜脈注射vancomycin治療。血液及結膜拭子採檢培養顯示了肺炎鏈球菌。核磁共振造影及電腦層顯示右眼鞏膜訊號加強及眼周軟組織腫脹。使用強力的全身及眼內抗生素治療，還是發生鞏膜融解併葡葡膜露出。最後病患接受了眼球摘除術及移植物置入，術後感染受到控制且病患的眼部在穩定狀況下出院。結論：內因性眼內炎的視力預後通常很差。早期診斷與積極的治療是拯救眼睛的關鍵。因為病原可能來自於身體的任何部位，醫師必須有所警覺地檢查眼睛，尤其是在那些因嚴重的全身性感染而無法陳述他們的眼部症狀的病人身上。

並列摘要

Purpose: To report a case of combined meningitis and endogenous endophthalmitis secondary to endocarditis caused by Streptococcus pneumoniae.Method: A case report.Result: A 42-year-old woman presented with a painful swelling of the right eye and disturbance of consciousness for two days. Systemic manifestations showed bacterial meningitis and endocarditis. Examination of the right eye revealed visual acuity of no light perception, ciliary injection, subconjunctival abscess, corneal edema, as well as exudates and fibrin in the anterior chamber. Combined endogenous endophthalmitis and meningitis secondary to bacterial endocarditis was impressed. Intravitreal injection (IVI) of vancomycin and ceftazidime and intravenous injection of vancomycin were performed. Culture of blood and conjunctival swab showed Streptococcus pneumonia. Despite intensive systemic and topical antibiotic therapy with repeated IVI and subconjuctival injection of antibiotics, progressive scleral melting with uveal exposure was noted. Eventually, enucleation with implant insertion was performed. The infection was under control after surgery and the patient was discharged with stable ocular condition.Conclusion: Endogenous endophthalmitis usually has a dismal visual outcome. Early diagnosis and aggressive treatment is the key to saving the eye. Since the pathogen might come from any part of the body, physicians should be alert to checking the eyes especially in those who might not be able to report their ocular symptoms due to severe systemic infection.

並列關鍵字

endogenous endophthalmitis ； infectious endocarditis ； meningitis ； Streptococcus pneumoniae