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要約 目的:B群溶連菌による心内膜炎に続発した内因性眼内炎の症例の報告。症例:59歳女性が両眼に突発した視力低下で受診した。4日前からの倦怠感と微熱があり,インフルエンザと診断されていた。不整脈の既往があった。姉がMarfan症候群で,人工血管置換術を受けていた。所見:矯正視力は右手動弁,左光覚弁で,両眼に虹彩毛様体炎の所見と硝子体混濁があった。心雑音があり,超音波検査で三尖弁と僧帽弁逆流があった。前房水と血液の培養で,Streptococcus agalactiaeが検出された。B群溶連菌による心内膜炎に続発した内因性眼内炎と診断した。抗菌薬の全身投与と硝子体注射,右眼への白内障と硝子体手術などを行った。初診から4か月後に寛解し,0.15の右眼視力を得た。結論:全身状態が不良でただちに硝子体手術ができない内因性細菌性眼内炎では,抗菌薬の全身と硝子体投与が病変の緩和に有用である。
Abstract. Purpose:To report a case of endogenous endophthalmitis secondary to group B Streptococcus endocarditis. Case:A 59-year-old female presented with suddenly impaired vision in both eyes. She had been diagnosed with influenza for general malaise and fever 4 days before. She had had arrhythmia before. Her sister had received cardiovascular surgery for complications of Marfan syndrome. Findings:Corrected visual acuity was hand motion right and light perception left. Both eyes showed signs of iridocyclitis and vitreous opacity. Streptococcus agalactiae was cultured from the blood and aqueous. She was diagnosed with endophthalmitis secondary to endocarditis. She was treated by topical and systemic antibiotics. The right eye received vitreous surgery,resulting in final visual acuity of 0.15 4 months later. Conclusion:This case illustrates that topical and systemic antibiotics may be effective for endogenous bacterial endophthalmitis when immediate radical treatment is not feasible.
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