クリのイガ刺入後に生じたMalassezia眼感染症の1例

A case of Malassezia endophthalmitis following corneal trauma by a chestnut bur

要約　目的：クリのイガが角膜に刺入したのちのMalassezia restrictaによる眼内炎の症例の報告。症例：60歳女性が前房蓄膿で紹介され受診した。3か月前にクリ拾いをしていてクリのイガが左眼に当たった。イガは4日後に摘出され治療を受けた。1か月前から眼痛が生じた。所見：矯正視力は右1.5，左1.2で，左眼角膜の4時方向にイガの刺入創と，その後面に白色浸潤があり，前房蓄膿を伴っていた。複数の抗菌薬の点眼と全身投与，ボリコナゾールの経口投与を行った。病変が悪化し，9日後に採取した前房水の遺伝子学的検索でMalassezia restrictaが検出された。通常の抗真菌薬は奏効せず，最終的にアムホテリシンBの点滴で寛解した。結論：角膜の異物刺入後に晩発性に角膜感染が生じ，Malassezia restrictaが原因で，アムホテリシンBが奏効した。

Abstract.　Purpose：To report a case of late corneal infection following trauma by a chestnut bur. Case：A 60-year-old woman was referred to us for hypopyon. She had suffered trauma by a chestnut bur in the left eye 3 months before. The bur was removed 4 days later followed by treatment. The left eye became painful since one month before. Findings：Corrected visual acuity was 1.5 right and 1.2 left. The left cornea showed opacity at 4 o'clock position with infiltration behind and hypopyon. The corneal lesion progressed after topical and systemic treatment with multiple antibiotics and peroral voriconazole. Aqueous humor tapped 9 days later showed Malassezia restricta by PCR amplification. Cure was obtained after intravenous amphotericin B. Conclusion：Late corneal infection following trauma by a chestnut bur was due to Malassezia restricta.