上顎洞炎に続発した眼窩部ガス壊疽の1例

A case of gas gangrene of the orbit secondary to maxillay sinusitis

　48歳男性の上顎洞炎に続発した非クロストリジウム性眼窩部ガス壊疽の症例を報告した。症例は右頬部痛，右眼瞼腫脹，右視力低下のため当科を受診した。初診時，右眼圧上昇，右中心フリッカー値と右対光反射の低下，右眼球結膜の浮腫・充血，右眼底に網膜静脈の怒張・蛇行と網膜出血を認めた。CTで右上顎洞内の陰影と右眼窩内および右眼窩周囲皮下組織に泡沫状のガス像がみられた。本症例の起炎菌として非クロストリジウム性嫌気性菌を想定し，早期に上顎洞根本術，眼窩開放術などの好気的外科処置を行い，リンコマイシン系を中心とした抗生物質を投与したところ，後遺症を残さず治癒することができた。

A 48-year-old male presented with pain in the right cheek, swelling of right eyelids and impaired right visual acuity. Initial examinations of the right eye showed edema and hyperemia of the bulbar conjunctiva, ocular hypotension, decreased critical flicker fusion frequency (CCF) , and decreased light reflex. Funducopy of the right eye showed dilatation and tortuosity of retinal veins with superficial retinal hemorrhages. Computed tomography of the head showed an inflammatory mass in the right maxillary sinus. Air bubbles were also present in the right orbit and priorbital subcutaneous tissue. The condition was tentatively diagnosed as gas ganrene of the orbit caused by non-clostridium anaerobic organism. Immediate aerobic surgical debridement with systemic clindamycin resulted in clinical cure without complications.