従来の抗真菌薬に抵抗を示した角膜真菌症に対しボリコナゾールが有効であった1例

Topical and systemic voriconazole was effective for keratomycosis resistant to conventional antifungal agents

要約　目的：新しいアゾール系抗真菌薬ボリコナゾールが奏効した角膜真菌症の症例の報告。症例：農作業中に32歳男性の右眼に異物が飛入した。3日後に眼科を受診し，角膜潰瘍と診断されたが軽快せず，その6日後に当科を受診した。4年前から糖尿病があった。所見と経過：視力は右1.2，左1.5であり，右眼の角膜に3mm径の潰瘍と浸潤があり，前房に強い炎症所見があった。角膜擦過物から糸状菌が検出され，フルコナゾールの点眼，ミコナゾールの点眼と点滴を行ったが病状は悪化し，12日後に右眼視力が0.05に低下した。角膜擦過物からAspergillus fumigatusが同定され，ボリコナゾールの点眼と点滴に変更した。角膜潰瘍と前房内炎症は軽快し，変更から22日後に視力は0.2に改善した。ボリコナゾールは3か月後に中止し，視力は1.5になった。結論：ボリコナゾールは角膜真菌症に対する治療の選択肢となり得る。

Abstract.　Purpose：To report a case of keratomycosis that responded to voriconazole. Case：A 32-year-old male was hit by a foreign body in his right eye while working in the open air. He was seen by an ophthalmologist 3 days later and was diagnosed as corneal ulcer. It progressed further and he was referred to us 6 days later. He had had diabetes mellitus since 4 years before. Findings：His visual acuity was 1.2 right and 1.5 left. The right eye showed a corneal ulcer with infiltration of 3mm in diameter. The anterior chamber showed intense signs of inflammation. Filamentous fungi were identified in the corneal scrapings. He received topical fluconazole and topical/systemic miconazole. The corneal lesion progressed further with visual acuity reduced to 0.05 12 days later and Aspergillus fumigatus was identified in the corneal scrapings. He started receiving topical and intravenous voriconazole followed by rapid improvements. Voriconazole was discontinued 3 months later. He regained the final visual acuity of 1.5. Conclusion：Voriconazole promises to be a treatment of choice for keratomycosis.