黒色真菌による眼内炎を生じ，最終的に眼球内容除去に至った1例

A case of endophthalmitis caused by dematiaceous fungi that led to evisceration

要約　目的：黒色真菌による眼内炎を生じ，最終的に眼球内容除去に至った1例を経験したので報告する。

症例：83歳，女性。主訴は視力低下。右眼の結節性強膜炎の治療中に前房内炎症が出現し，前医へ紹介された。前医では前房消失，前房蓄膿，毛様充血，併発白内障を認めた。水晶体融解性ぶどう膜炎を疑い，水晶体囊内摘出術と前部硝子体切除術が施行された。炎症は一度改善し，2か月後に眼内レンズ縫着術が行われた。しかし，その後眼内炎症が増悪し，当科を紹介された。当院初診時の右眼視力は光覚弁で，前房蓄膿，毛様充血，およびBモード超音波検査で網膜剝離を認め，細菌性眼内炎を疑った。前房水の培養・顕微鏡検査は陰性だったが，PCRでは細菌18S ribosomal RNAが陽性となった。細菌性眼内炎として加療されたが，徐々に状態は増悪し，当院初診1か月後に眼球内容除去術が施行された。採取した硝子体液と眼内レンズから，黒色真菌の一つであるPhialophora属が同定された。術後にボリコナゾール投与を2週間行い，感染の再燃はなく経過良好であった。

結論：治療抵抗性の眼内炎の原因の一つとして，黒色真菌に注意が必要である。

Abstract　Purpose：This report presents a case of endophthalmitis caused by a dematiaceous fungus（black fungus） that led to evisceration.

Case：An 83-year-old woman presented with blurred vision. Inflammation in the anterior chamber was noted during the treatment of nodular scleritis of the right eye. Therefore, she was referred back to the previous physician. Visual acuity in the right eye at the first visit was light perception. Slit-lamp microscopy revealed the flat anterior chamber, hypopyon, ciliary injection, and secondary cataracts. Phacoanaphylactic endophthalmitis was suspected；consequently, lens enucleation and anterior vitrectomy were performed. The inflammation improved two months postoperatively. Ciliary suture fixation of the intraocular lens was performed. However, the intraocular inflammation worsened. Bacterial endophthalmitis was suspected, and the patient was referred to our hospital. The ocular condition gradually worsened despite treatment for bacterial endophthalmitis. Evisceration of the right eye was performed one month later.

Findings：Visual acuity in the right eye at the first visit was light perception. B-mode echography revealed hypopyon, ciliary injection, and retinal detachment in the right eye. Culture and speculum examination of the anterior chamber fluid were negative；however, PCR for bacterial 18S rRNA was positive（4.0×10⁴ copies/mL）. Anterior chamber irrigation with antibiotics and medications for bacterial endophthalmitis was performed；however, the condition of the eye worsened gradually. Evisceration of the right eye was performed one month after the initial visit to our clinic as recovery of vision was deemed difficult. Phialophora sp., a black fungus, was detected in the vitreous humor and extracted intraocular lens.

Conclusion：Black fungi may cause treatment-resistant endophthalmitis.