Clostridium perfringensによる内因性全眼球炎の1例

A case of endogenous panophthalmitis due to Clostridium perfringens

要約　目的：Clostridium perfringensによる内因性全眼球炎の症例の報告。症例と経過：87歳女性が4日前からの心窩部痛と嘔吐，2日前からの左眼視力障害と眼痛で受診した。矯正視力は右0.4，左光覚なしであり，眼圧は右12mmHg，左56mmHgで，急性閉塞隅角緑内障と診断し，レーザー虹彩切開術を行った。翌日前房出血が生じ，CT検査で硝子体内にガス像が認められた。全身検査で胆囊炎と肝膿瘍が発見された。内科治療で全身状態は改善したが，受診の4日後に角膜が穿孔し，眼球内容除去術が行われた。眼球内容物から嫌気性グラム陽性桿菌であるC. perfringensが検出された。結論：眼内にガス像が見られるときには，ガス壊疽の原因でもある本菌による感染症の可能性がある。

Abstract.　Purpose：To report a case of endogenous panophthalmitis due to Clostridium perfringens. Case and Findings：A 87-year-old woman presented with abdominal pain and vomiting since 4 days before and with pain and impaired vision in her left eye since 2 days before. Her visual acuity was 0.4 right and no light perception left. The intraocular pressure was 12mmHg right and 56mmHg left. She received laser iridotomy under the diagnosis of acute closed-angle glaucoma. The left eye showed hyphema the next day. Computed tomography showed air bubble in the vitreous. Systemic examinations showed cholecystitis and liver abscess. The cornea perforated 4 days after her initial visit, necessitaging evisceration. C. perfringens, which may cause gas gangrene, was isolated from the surgically obtained specimen. Conclusion：Presence of gas bubble in the vitreous may be a sign of infection by C. perfringens.