Cytomegalovirus as a Cause of Corneal Endotheliitis in an Immunocompetent Patient

巨細胞病毒在一位免疫正常的病人表現角膜內皮細胞炎－病例報告

陳婉如(Wan-Ju Chen) ； 曾順輝(Sung-Huei Tseng) ； 黃福進(Fu-Chin Huang) ； 許聖民(Sheng-Min Hsu) ； 陳盈廷(Ying-Ting Chen)

《中華民國眼科醫學會雜誌》 49卷1期 (2010/03) Pp. 42-48

https://doi.org/10.30048/ACTASOS.201003.0006

摘要

目的：報告一例免疫系統功能正常的病人，因巨細胞病毒感染造成角膜內皮細胞炎。
方法：病例報告。
結果：一位68歲的女性主訴右眼視力模糊達兩月之久。診所診斷為高壓性虹彩炎，並施予局部類固醇及青光眼藥水治療，雖眼壓得到控制，但是角膜水腫持續進展。風濕免疫系統檢查大致正常，因臨床症狀懷疑為單純疱疹病毒感染，於是投以系統性抗疱疹藥物valacidovir。內皮細胞檢查顯示內皮細胞數下降，之後進行的前房房水抽出送驗，結果顯示有巨細胞病毒的核酸存在，證實為巨細胞病毒感染。病人接受一次玻璃體內ganciclovir注射後，因擔心全身性抗巨細胞病毒藥物之副作用而暫緩治療。六個月後，再次接受口服valganciclovir治療三個月，但角膜持續水腫無法恢復。
結論：當病人出現角膜內皮細胞炎時，要將巨細胞病毒感染放在鑑別診斷中。而前房液抽取作病毒核酸檢驗對於確立診斷而言是相當重要的。

並列摘要

Purpose: To report a case of Cytomegalovirus (CMV)-associated corneal endotheliitis in an immunocompetent patient and review the literature. Method: a case report.
Results: A 68-year-old woman was referred to us with blurred vision and progressive corneal edema in the right eye for two months. Before referral, she was diagnosed as anterior uveitis complicated with elevated intraocular pressure (IOP) by a local practitioner. Even though IOP was controlled with antiglaucomatous medications, a progressive corneal edema developed and was refractory to medical treatments. We thus conducted a thorough rheumatologic survey, which however showed all negative results. Given that herpes simplex uveitis was suspected, systemic valaciclovir was given but in peril. Diagnostic anterior chamber tapping was performed and PCR detected the presence of CMV DNA in aqueous humor. Serum tests also showed positive result for CMV IgG but negative for CMV antigen and HIV. After receiving a single dose of intravitreal ganciclovir 2mg/0.1ml, the patient refused further systemic antiviral regimen for the concern of adverse effect. Six months later, the patient returned to complete a course of 3-month systemic valganciclovir treatment (900 mg p.o. twice daily for 6 weeks, followed by 450 mg twice daily for another 6 weeks); Despite the subside of viral infection by intensive anti-viral regimen, the irreversible endothelial damage resulted in persistent corneal edema.
Conclusion: CMV infection should be included in the differential list of the causes of corneal endotheliitis. Aqueous humor analysis is crucial for the definitive diagnosis.

並列關鍵字

cytomegalovirus ； corneal endotheliitis ； anterior uveitis ； ganciclovir