DSAEK術後の角膜感染症に対し網羅的病原体ゲノム解析を行った1例

Comprehensive pathogenic genome analysis in a case of corneal infection following Descemet's stripping automated endothelial keratoplasty（DSAEK）

要約　目的：角膜内皮移植（DSAEK）術後に発症した角膜炎に対し，混合感染を疑い網羅的病原体ゲノム解析を行った1症例を報告する。

症例：89歳女性，水疱性角膜症に対してDSAEK施行後約1か月目に樹枝状病変が認められた。角膜ヘルペスを疑い，アシクロビル眼軟膏にて一時改善するも，遷延性上皮欠損が出現し，さらに羽毛状角膜浸潤を認めた。混合感染を疑い網羅的病原体ゲノム解析を施行，全リード数は2,435,307本で真菌由来が636,661本で99.7％がCandida parapsilosisであった。ウイルス由来リードは検出されなかった。培養にてC. parapsilosisが検出されたため，真菌性角膜炎と診断し，ピマリシン眼軟膏投与で改善した。

結論：角膜移植術後は易感染状態であり，混合感染の有無を確認するのに網羅的病原体ゲノム解析が有用であった。

Abstract　Purpose：To report a case of corneal infection following Descemet's stripping automated endothelial keratoplasty（DSAEK）who was diagnosed after comprehensive pathogenic genome analysis.

Case：An 89-year-old woman received DSAEK for bullous keratopathy in her right eye. She had received cataract surgery with intraocular lens implantation 20 years before. The right eye developed dendritic keratopathy one month after DSAEK and was treated by acyclovir ointment. The corneal lesion developed into persistent epithelial defect with feather-like corneal infiltration. She was suspected of mixed infection and received after comprehensive pathogenic genome analysis.

Results：Out of a total of 2,435,307 leads, 636,661 were derived from fundus species, of which 99.7％ were Candida parapsilosis. There was no lead from virus. Culture of corneal lesion showed C. parapsilosis. She was diagnosed with fungal keratitis and improved following topical treatment with pimaricin.

Conclusion：This case suggests that the cornea is liable to infection following DSAEK. Comprehensive pathogenic genome analysis was useful in ruling out the possibility of mixed infection.