内因性細菌性眼内炎の4例

Four cases of endogenous bacterial endophthalmitis

要約　背景：細菌性内因性眼内炎は疾患に特異的な臨床所見に乏しく，初期には非細菌性ぶどう膜炎に類似するため，診断が難しい。目的：細菌性内因性眼内炎の4症例の報告。症例：症例はそれぞれ58，64，80，95歳で，1例が両眼性，3例が片眼性であった。原因疾患は，緑膿菌による肺炎，肺炎桿菌による腎膿瘍（両眼性），黄色ブドウ球菌による腎膿瘍，ブドウ球菌による尿路感染症の各1例であった。3例では眼科受診時に白血球増加があり，全例で全身のCTが診断確定に有用であった。5眼中2眼では硝子体手術により消炎し，3眼では眼球摘出に至った。結論：ぶどう膜炎では，感染症を示唆する前駆症状や，免疫能低下につながる基礎疾患があるときには，細菌性内因性眼内炎の可能性があり，早期診断と治療が望まれる。

Abstract.　Background：Endogenous bacterial endophthalmitis may present diagnostic difficulties because of nonspecific symptoms of uveitis in its initial stage. Purpose：To present 4 cases of endogenous bacterial endophthalmitis. Cases：The present series comprised one male and 3 females. They were aged 58, 64, 80 and 95 years respectively. Three were unilaterally and one was bilaterally affected. Three cases showed leukocytosis. Endophthalmitis was secondary to pneumonia due to Pseudomonas aeruginosa, renal abscess due to Klebsiella pneumoniae, renal abscess due to Staphylococcus aureus, and urinary tract infection in one case each. Computed tomography was useful in the diagnosis in all the cases. Vitrectomy was followed by improvement in 2 eyes. Eventual enucleation was necessary in 3 eyes. Conclusion：Cases suspected of endogenous bacterial ophthalmitis need early diagnosis and treatment.