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巴里諾氏眼淋巴腺症候群－病例報告
Parinaud's Oculoglandular Syndrome-A Case Report
摘要
目的：報告一例巴里諾氏眼淋巴腺症候群病患診斷及治療。 方法：病例報告。 結果：22歲男大學生，97年1月因漸進性左頸腫大及疼痛十天，合併發燒一天至急診室求診。就診前一星期，左眼結膜及下眼瞼出現紅腫熱痛合併異物感。病史詢問得知2星期前被家裡的小貓抓傷左大腿，理學檢查結果顯示：左眼結膜炎及眼瞼軟骨後結膜肉芽腫(retrotarsal conjunctival granuloma)，左頸有約5公分直徑的淋巴結合併壓痛且固定不動。臨床診斷為貓抓病(cat scratch disease)合併巴里諾氏眼淋巴腺症候群(Parinaud's oculoglandular syndrome)，給予病患minocycline 100毫克，每12小時靜脈注射一次，及rifampin 600毫克，每天口服一次，治療二天後發燒改善，左眼紅腫也改善，住院一周後改口服抗生素出院，在出院一周後門診追蹤時左眼紅腫已完全改善，而雖仍有頸部淋巴節腫痛症狀，但已較剛住院時改善。 結論：貓抓病是一個感染性疾病，巴東體屬細菌(Bartonella henselae)是最主要造成貓抓病的致病菌。有2~8%貓抓病的病人會出現巴里諾氏眼淋巴腺症候群，這個症候群的症狀包括結膜炎、眼瞼軟骨後結膜肉芽腫及局部耳前及頸部淋巴結腫大。貓抓病及其併發症的治療主要是症狀治療及施予抗生素。
關鍵字
無資料並列摘要
Purpose: To report a case of Parinaud's oculoglandular syndrome. Methods: A case report. Results: A 22 y/o young man complained of painful swelling of his left neck for 10 days with monocular red eye with foreign body sensation for 7 days and fever for 1 day after a cat had scratched him two weeks ago. Physical examination showed left eye conjunctivitis, retrotarsal conjunctival granuloma and left neck lymphadenopathy. Under the impression of cat-scratch disease, complicated by Parinaud's oculoglandular syndrome. We used minocycline 100mg IV Q12H and rifampin 600mg PO QD to treat this patient. Conjunctivitis improved and his fever subsided after 2 days of treatment. We discharged him one week after admission and switched antibiotics to the oral form. His red eye completely recovered and neck lymphadenopathy also improved in the follow up. Conclusions: Cat scratch disease (CSD) is an infectious disease. Bartonella henselae is the etiologic agent in most cases of CSD. Parinaud's oculoglandular syndrome is an atypical form of CSD, reported from two to eight percent of patients with CSD, and can include conjunctivitis, retrotarsal conjunctival granuloma, and adjacent preauricular and cervical lymphadenopathy. The treatments of CSD include symptom-relieving agents and antibiotics.