Herpes Zoster Ophthalmicus Presenting as Orbital Cellulitis-A Case Report

以眼窩蜂窩組織炎表現之帶狀疱疹眼症：病例報告

蘇皓琳(Hao-Lin Su) ； 汪宜樺(I-Hua Wang) ； 梁怡珈(I-Chia Liang) ； 林素玲(Shun-Ling Lin)

《中華民國眼科醫學會雜誌》 52卷1期 (2013/04) Pp. 38-43

https://doi.org/10.30048/ACTASOS.201304_52(1).0007

摘要

目的：描述一個以眼窩峰窩組織炎為初期表現的帶狀疱疹眼症病例。方法：病例報告。結果：一位患有多種慢性疾病的61歲女性，因發燒，頭痛及血壓高入住內科病房。因她一週前才完成敗血症治療而出院，故再度當作敗血症接受靜脈注射抗生素治療。因患者同時有左眼眼痛和眼瞼腫脹一週之久，所以照會眼科，初步診斷為左眼隔膜前峰窩組織炎。第二天患者眼窩紅腫疼痛急速加劇，合併有眼瞼下垂及眼球運動功能受限之症狀。緊急做電腦斷層掃描，診斷為眼窩蜂窩組織炎，接受緊急手術，但並未明顯改善。手術後兩天，左前額和眼周冒出水疱，才診斷為帶狀疱疹眼症。經過五天的抗病毒藥物治療後病人情況改善而出院。在門診追蹤約三個月後，眼瞼下垂及眼球運動功能受限的情形己幾乎完全改善。結論：帶狀疱疹病毒可以造成眼部許多併發症，但罕見以眼窩峰窩組織炎做為表現。這個病例提醒我們對免疫功能不好的患者，需將帶狀疱疹眼症放入眼窩峰窩組織炎的鑑別診斷。

並列摘要

Purpose: To report a case of herpes zoster ophthalmicus with initial presentation as orbital cellulitis.Methods: Case report.Results: A 61-year-old immunocompromised female was admitted to the department of internal medicine due to fever and was treated for sepsis with systemic antibiotics. She also had a 7-day history of left sided headache and left eye pain associated with progressive eyelid swelling and conjunctival chemosis. Preseptal cellulitis (OS) was initially impressed after ophthalmology inpatient consultation. The following day, rapid progression of redness and swelling of eyelid with severe eye pain developed (OS). Ophthalmic examination revealed marked eyelid swelling, ptosis, and complete restriction of ocular movement (OS). Emergent orbital CT showed extraocular muscles swelling and infiltration of retrobulbar fat (OS). She underwent emergent anterior orbitotomy and local antibiotics irrigation under the impression of orbital cellulitis (OS). However, two days later, vesicular eruptions developed over her left forehead corresponding to the distribution of the first branch of the trigeminal nerve. Under the diagnosis of herpes zoster ophthalmicus (HZO), she was treated with intravenous acyclovir. Following a 9-day course of Flomoxef and a 5-day course with an antiviral agent, she was discharged in an improved condition. Her ptosis and restriction of ocular motility gradually recovered during 3 months of follow-up.Conclusion: We presented a case of ophthalmic herpes zoster initially presenting as fulminant orbital cellulitis. Orbital herpes zoster infection should be considered in an immunocompromised patient with characteristics of orbital cellulitis.

並列關鍵字

Orbital Cellulitis ； Herpes Zoster Ophthalmicus