早期の抗菌薬硝子体注射が良好な視力回復につながったと考えられる細菌性転移性眼内炎の1例

A case of successful treatment of endogenous bacterial endophthalmitis from the early intravitreal injection of anti-bacterial agents

要約　目的：眼科初診時から細菌性転移性眼内炎を疑い，早期に抗菌薬硝子体注射を開始したことによって良好な視力改善が得られた症例の報告。

症例：76歳女性。3日前からの急激な視力低下を主訴に当院へ初診となった。左眼に前房内細胞浮遊，びまん性硝子体混濁，眼底下方に網膜出血斑と滲出斑があり，左視力は（0.01）と不良であった。血中CRPの上昇，白血球増多と，多くの基礎疾患があったことから，細菌性転移性眼内炎が疑われ，同日にセフタジジム/バンコマイシンの硝子体注射が施行された。翌日から39℃台の発熱を認め，セフトリアキソン1gの全身投与が開始された。第4日病日に血液・尿培養でEscherichia Coliが検出され，腰椎化膿性脊椎炎も合併していると診断され，セファゾリン3gに変更された。第5病日にセフタジジム硝子体注射が追加された。眼病変は治療に良く反応し，治療開始2か月時点では眼底にわずかな萎縮巣を残すのみとなり，左視力は（0.9）へと改善した。

結論：本症例では，初診時の眼所見と血液検査所見から積極的に細菌性転移性眼内炎を疑い，全身精査を行いながら，直ちに抗菌薬硝子体注射を開始したことが良好な視機能予後につながったと考えられる。

Abstract　Purpose：To report a case of successful treatment of endogenous bacterial endophthalmitis from the early intravitreal injection of anti-bacterial agents.

Case：A 76-year-old female complained of a sudden loss of vision from 3 days before presentaion. visit. Cells in the anterior chamber, diffused vitreous opacity, dots hemorrhage and retinal infiltrate in the inferior part of the ocular fundus were observed. Left best corrected visual acuity（BCVA）was 0.01. A history of various systemic diseases were present. High C-reactive protein and leucocytosis were observed in blood examination. We considered endogenous bacterial endophthalmitis from systemic and intraocular findings. Vitreal injection of ceftazidime and vancomycin was performed on the same day. Body temperature was elevated to 39 degrees Celcius, systemic treatment of Ceftriaxone was added. Eschericia coli was detected in blood and urine culture on the fourth day of disease. She was later diagnosed with lumbar purulent spondylitis, and antibacterial drug was changed to Cefazolin. Vitreous injection of ceftazidime was added on the 5 day. These treatments were effective on her ocular findings, her BCVA was recovered to 0.9 at two months later.

Conclusion：In this case, it is considered that the positive suspicion of endogenous bacterial endophthalmitis from the ocular and blood examination findings at the initial diagnosis, and the immediate start of intravitreal injection of antibacterial agents while undergoing systemic examination, led to a good visual prognosis.