眼瞼結膜下に黒色真菌感染を再燃した1例

A case of recurring black fungus infection under the palpebral conjunctiva

要約　目的：眼瞼結膜下に黒色真菌感染を再燃した症例を報告する。

症例：47歳，男性。37歳時にHIV感染症と診断され，40歳時よりAIDSとして加療が開始された。44歳時に左眼の充血と左下眼瞼結膜に黒色腫瘤が出現し，精査加療目的で当科へ紹介され初診となった。47歳時に所見が再燃したと訴え再来した。

所見：初診時，左下眼瞼結膜の著明な充血を認め，瞼結膜下に黒色腫瘤を認めた。腫瘤の周囲には結膜下結石を多数認め，黒色腫瘤は一部が瞼結膜から露出していた。黒色腫瘤は細菌検査および鏡検の結果，黒色真菌と判明した。再燃時，原因となった黒色真菌はExophiala dermatitidisであると同定された。

結論：免疫能低下状態にある患者において，眼瞼結膜下に黒色真菌感染を繰り返す症例が存在する。

Abstract　Purpose：To report a case of recurring black fungus infection under the palpebral conjunctiva.

Case：A 47-year-old man. He was diagnosed with human immunodeficiency virus（HIV）infection at the age of 37 years and his treatment began as an acquired immunodeficiency syndrome（AIDS）since the age of 40 years. Four black tumors appeared with congestion on his left lower palpebral conjunctiva at the age of 44. He complained that the findings reemerged when he was 47 years old.

Findings：At the first time, four black tumors were found at the lower left palpebral conjunctiva with congestion. A large number of subconjunctival calculi were observed around the tumors, and a part of the black mass was exposed from the palpebral conjunctiva. The black clumps were found to be black fungus by bacterial and microscopic examination. At the second time, it was identified that the black tumors were caused by Exophiala dermatitidis.

Conclusion：Patients with immunocompromised states have cases in which black fungus infections are repeated locally.