毛虫の毒針毛による眼内炎の1例

A case of endophthalmitis caused by caterpillar setae

要約　48歳男性が右眼視力低下で受診した。8日前に木を伐採中，右眼を拭った腕に毛虫が付着していた。同日某医で右瞼結膜に刺入した数本の毛を除去されたが，その後視力が低下し，眼内炎が指摘されていた。右眼は矯正視力0.01で，前房蓄膿と硝子体混濁があった。前房洗浄と硝子体切除術を行った。術中に採取した眼内組織からの細菌と真菌培養は陰性であった。薬物療法で炎症は軽快し，右眼視力は0.6に改善した。2か月後に眼内炎が再発し，視力が0.04に低下した。薬物投与で硝子体混濁が軽快したときに，小さな線状の硝子体混濁が2個発見された。再度の硝子体切除術中に，硝子体内に2本の毒針毛と毛様体扁平部に1本の毒針毛を発見し，摘出した。以後経過は良好で，1.2の視力を維持している。前房蓄膿を伴う眼内炎で，毛虫と接触した既往がある際には毒針毛による可能性があり，線状の硝子体混濁の存在が診断確定に有用であることを示す症例である。

Abstract.　While a 48-year-old man was trimming a tree 8 days before,he found a caterpillar on his arm with which he had rubbed his right eye. Caterpillar setae were detected and removed from his bulbar conjunctiva the same day. He was referred to us for endophthalmitis.His visual acuity was 0.01 and the affected eye showed hypopyon and vitreous opacity. He received anterior chamber irrigation and vitrectomy. Culture of intraocular specimen was negative for bacteria or fingi. Treatments with medication was followed by improved inflammation and visual acuity of 0.6. Endophthalmitis recurred 2 months later and the visual acuity decreased to 0.04. After vitreous opacity had subsided with medications,we detected two tiny linear opacities in the vitreous. During another vitrectomy,we identified and removed two linear opacities in the vitreous and another in the pars plana. He has been doing well with the visual acuity of 1.2. This case illustrates that capillary setae may induce endophthalmitis with hypopyon after contact with a caterpillar. Detection of tiny linear vitreous opacity is useful in the diagnosis.