激しい筋肉痛と高熱を伴ったG群溶血性連鎖球菌による内因性眼内炎の1例

A case of endogenous endophthalmitis due to group G streptococcus with severe myalgia and high fever

要約　目的：激しい筋肉痛と高熱を伴ったG群溶血性連鎖球菌による内因性眼内炎の症例の報告。症例：31歳男性が1日前からの右眼の眼痛と視力低下で受診した。3日前から発熱と嘔吐，1日前から全身の筋肉痛と腎不全があった。所見：矯正視力は右指数弁，左1.5で，右眼に眼瞼浮腫，球結膜の充血，角膜浮腫，虹彩外反があり，眼底は透見不能であった。血液培養でG群溶血性連鎖球菌が検出された。通常の抗生物質の全身投与で熱発と高炎症反応が持続した。発症から6週間後に感染性心内膜炎に準じた抗生物質の大量投与で全身症状が速やかに改善した。結論：病原性が強いG群溶血性連鎖球菌による全身感染では，基礎疾患がない健常者に強い内因性眼内炎が生じることがある。

Abstract.　Purpose：To report a case of endogenous endophthalmitis due to group G streptococcus with severe myalgia and high fever. Case：A 31-year-old male presented with pain and impaired vision in his right eye since the day before. He had had high fever and vomiting since 3 days before,and generalized myalgia and renal failure since the day before. Findings：Visual acuity was counting fingers right and 1.5 left. The right eye showed lid edema,conjunctival hyperemia,corneal edema and ectropium iridis. The fundus was not visible. Blood culture showed group G streptococcus. High fever and myalgia continued after systemic treatment with conventional antibiotics. Massive dosis of new antibiotics,indicated for bacterial endocarditis,was started 6 weeks after onset and was followed by rapid improvement of systemic findings. Conclusion：This case illustrates that strongly pathogenic strain of group G streptococcus may induce endophthalmitis with severe systemic manifestations in apparently healthy individual.