アトピー性皮膚炎患者に発症した内因性感染性眼内炎の1例

Endogenous bacterial endophthalmitis in a patient of atopic dermatitis

要約　背景：内因性感染性眼内炎は若年者には少なく，アトピー性皮膚炎患者に発症した報告もない。目的：若年のアトピー性皮膚炎患者に生じた内因性感染性眼内炎の報告。症例：18歳男性が数日前からの左眼の飛蚊症と視力低下で受診した。全身にアトピー性皮膚炎があった。漢方薬を内服し，ステロイドは使用していなかった。3年前に左右眼のどちらかに角膜ヘルペスがあった。所見：矯正視力は右1.0，左光覚弁であった。左眼に前房蓄膿と硝子体混濁があり，超音波検査で網膜剝離が疑われた。ステロイド剤の局所と全身投与に反応せず，初診から2週間後に硝子体手術を行った。硝子体から黄色ブドウ球菌が培養された。5か月後に治癒し，0.4の視力を得た。眼内炎の感染源は不明であった。結論：本症例での眼内炎には，アトピー性皮膚炎がなにかの形で関与している可能性がある。

Abstract.　Background：Endogenous bacterial endophthalmitis is rare in young persons and has not been reported in patients with atopic dermatitis. Purpose：To report endogenous bacterial endophthalmitis in a young person with atopic dermatitis. Case：An 18-year-old male presented with blurring in his left eye since a few days before. He had been suffering from atopic dermatitis and been treated with non-steroidal drug. He had suffered herpetic keratitis 3 years before. Findings：His corrected visual acuity was 1.0 right and light perception left. The left eye showed hypopyon and dense vitreous opacity. Echography showed findings suggestive of retinal detachment. Vitrectomy was performed 14 days later after topical and systemic corticosteroid failed. Staphylococcus aureus was detected from the vitreous specimen. Cure was obtained 5 months later with visual acuity of 0.4. The source of infection could not be identified. Conclusion：There is a possibility that atopic dermatitis was etiologically involved in this patient.