小児淋菌性眼窩隔膜前部蜂巣炎の1例

Gonococcal orbital preseptal cellulitis in an infant

要約　目的：乳児に生じた淋菌性眼窩隔膜前部蜂巣炎の報告。症例：1歳1か月の女児が左眼の腫脹と眼脂で受診した。2日前にベッドから転落して左眼周囲に皮下出血があり，1日前から眼脂が増加し，当日朝から眼瞼腫脹で開瞼不能になった。父親に複数回の淋菌性尿道炎の罹患歴がある。所見と経過：眼脂は黄白色膿性であり，アデノチェックは陰性，体温は37.4℃であった。4日後の再来時のCT検査で眼窩隔膜前部蜂巣炎の所見があり，初診時に採取した膿から淋菌が検出された。セフトリアキソンの点滴を行い，初診から12日後に完治した。両親からは淋菌は検出されなかった。結論：淋菌による急性結膜炎が乳児に発症することがある。非典型的な結膜炎では，培養と感受性検査を速やかに行い，対処することが望ましい。

Abstract.　Purpose：To report gonococcal conjunctivitis and orbital preseptal cellulites in an infant. Case：A one-year-old female infant presented with swelling and discharge in her left eye. She had fallen from her bed 2 days before resulting in subcutaneous hemorrhage around the left eye. The discharge had increased the next day. She could not open her left eye since morning of her visit. Her father had multiple history of gonococcal urethritis. Findings：Discharge from the left eye was yellowish putrid. Adenocheck was negative. Body temperature was 37.4℃. Four days later,she was diagnosed with orbital preseptal cellulites from CT findings from the day of her first visit. Gonococcus neisseriae was cultured from the discharge. Systemic ceftriaxone was followed by cure on day 12 of the disease. Her parents were found negative for gonococcal infection. Conclusion：This case illustrates that acute gonococcal conjunctivitis may occur in an infant after one year of age. This possibility has to be kept in mind when dealing with atypical conjunctivitis.