Bilateral Endogenous Pseudomonas Endophthalmitis in a Burn Patient

燒傷病患罕見併發症之雙側內源性綠膿桿菌眼內炎

蔡佳津(Chia-Chin Tsai) ； 何建良(Chien-Liang Ho) ； 陳琮琳(Chung-Lin Chen) ； 蕭淑方(Shu-Fang Hsiao) ； 潘信誠(Shin-Chen Pan)

《臺灣整形外科醫學會雜誌》 27卷2期 (2018/06) Pp. 119-125

摘要

Background: Endogenous endophthalmitis, which results from hematogenous spread of infection from the extra-ocular region, is a rare and potentially devastating disease related to intraocular inflammation. Patients may exhibit ocular symptoms such as generalized eye redness, ocular pain, eyelid swelling, and total loss of vision. Misdiagnosis or delayed diagnosis is not uncommon due to its low incidence and symptom variability. Endogenous endophthalmitis in major burn patients is extremely rare and to date, only 3 cases have been reported in the literature. Aim and Objects: This report presents a rare case of bilateral endogenous Pseudomomas endophthalmitis found in a major burn patient. The course of disease and treatment was described. Materials and Methods: The authors describe a case involving a 77-year-old man with multiple comorbidities who sustained flame burns to 34% of his total body surface area. The patient suffered from episodes of septicemia and developed bilateral endogenous pseudomonas endophthalmitis 43 days after injury with presentation of swollen red eyes, purulent discharge, vitreous lucency haziness, and diminished light reflex. Results: Despite loss of light perception in his right eye, visual acuity in the left eye was successfully salvaged via early detection and precise aggressive intravitreal and systemic antibiotic treatment. Conclusion: Possible predisposing factors for endogenous endophthalmitis in burn patients include severity of burn injury, old age, underlying comorbidities, and multiple complications and episodes of septicemia during hospitalization. The authors emphasize on the importance of early diagnosis and adequate treatment in order to achieve most optimal result.

關鍵字

endogenous endophthalmitis ； burn

並列摘要

背景：內源性眼內炎為一罕見且後果可能極為嚴重的急症，微生物感染病患身體其他部位後經血行性傳播，通過血眼屏障造成眼內的感染發炎。臨床症狀常以眼睛紅、眼部疼痛、眼部腫脹、畏光，視力模糊甚至視力喪失表現。因為此疾病不常見並且症狀多元，往往導致誤診或是延遲診斷，在大面積燒傷病患身上併發的內源性眼內炎更為罕見，目前關於此類病患的報導在英文文獻上只有有限的案例報告。目的及目標：藉由一位大面積燒傷病患併發雙側內源性綠膿桿菌眼內炎的案例，我們描述了疾病的病程、症狀的表現，以及鑑別診斷和治療的過程。材料及方法：我們提出一位77歲具有多重慢性共病症的男性受到體表面積34%嚴重燒傷，在住院第43天開始 表現出眼睛紅腫熱痛、玻璃體混濁、眼部蓄膿、光反射下降，鑑別分析診斷為全身細菌性敗血症併發雙側內源性綠膿桿菌眼內炎。結果：經過及早診斷、積極靜脈抗生素治療、玻璃體內抗生素注射，病患感染獲得控制。雖然右眼視力喪失，左眼發炎得以消退，視力逐漸恢復。結論：燒傷病患併發內源性眼內炎常見的危險因子包含高齡、病患本身的合併症及造成免疫缺失或不全的狀況、燒傷嚴重程度、住院期間發生併發症及菌血症等。謹慎的評估，早期診斷以及及時的治療才可以幫助病患得到最好預後。