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要約 目的:植物の突き目を契機として角膜真菌症が発症し,遺伝子診断で原因がAlternaria alternataと同定された症例の報告。症例:76歳男性が左眼の眼痛と視力低下で受診した。3週間前に蠟梅の植え替えをしていて眼に異物が飛入し,虹彩炎として近医で加療中であった。所見:矯正視力は右1.0,左0.2で,左眼の角膜中央部より外下方に混濁があり,前房内に炎症細胞があった。病巣の擦過により角膜真菌症と診断し,ピマリシン眼軟膏で治療した。病巣は改善し,2週間後には瘢痕治癒した。擦過物の分子生物学的DNA配列の検索で,Alternaria alternataが同定された。結論:Alternaria alternataによる角膜真菌症は,病変が角膜浅層に限局するので,本症例のように経過が良好であることが多い。
Abstract. Purpose:To report a case of keratomycosis that proved to be due to Alternaria alternata. Case:A 76-year-old male presented with pain and impaired vision in the left eye. He had noticed foreign body sensation in the eye while caring for a miniature tree 3 weeks before. He had been under treatment as iridocyclitis. Findings:Corrected visual acuity was 1.0 right and 0.2 left. The left cornea showed an ill-defined opacity lower and temporal to the vertex. Signs of iritis were present. Smear from the corneal lesion led to the diagnosis of keratomycosis and treatment with topical pimaricin. The corneal lesion was cured leaving scarring 2 weeks later. Analysis of DNA sequence showed the causative organism to be Alternaria alternata. Conclusion:This case illustrates that keratomycosis due to Alternaria alternata may run a benign course as the corneal lesion tends to be confined to the anterior layers only.
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