硝子体液中β-D-グルカンおよび真菌PCRが眼内炎の診断・治療に有用であった1例

A case of endophthalmitis diagnosed by intravitreal beta-D-glucan level and fungal polymerase chain reaction

要約　目的：真菌性眼内炎の症例の報告。症例：51歳女性が1か月前からの右眼視力低下で受診した。糖尿病，鉄欠乏性貧血，肝硬変があり，1年前に外傷後の膝窩部膿瘍の既往があった。所見と経過：矯正視力は右0.01，左1.2で，右眼には前房の混濁，索状の硝子体混濁，黄斑部に白色滲出があった。真菌性眼内炎を疑い，抗真菌薬を全身投与したが硝子体混濁がさらに悪化し，1週間後に硝子体手術を行った。採取した硝子体の鏡検と培養で真菌は検出されなかったが，β-D-グルカンが高値であり，真菌PCR法でCandida albicansが同定され，真菌性眼内炎と診断した。抗真菌薬を続けて投与し，8週間後に黄斑部の滲出は瘢痕化し，0.08の視力を得た。結論：真菌性眼内炎の補助診断法として，硝子体内のβ-D-グルカンの定量と真菌PCR法が本症例では有用であった。

Abstract.　Purpose：To report a case of endogenous fungal endophthalmitis. Case：A 51-year-old female presented with blurring in her right eye since one month before. She had a history of diabetes mellitus,iron-deficiency anemia,and liver cirrhosis. She had had trauma-induced infection in the left knee one year before. Findings：Corrected visual acuity was 0.01 right and 1.2 left. The right eye showed signs of iritis,vitreous opacity,and exudative mass in the macula. Systemic antifungal drug was ineffective necessitating vitrectomy one week later. No fungus was detected in the vitreous specimen either by microscopy or culture. The vitreous showed high level of β-D-glucan. Candida albicans was detected by polymerase chain reaction（PCR）. Systemic treatment with antifungal agent resulted in scarring of macular lesion with visual acuity of 0.08 eight weeks later. Conclusion：This case illustrates that β-D-glucan level in the vitreous and PCR of vitreous specimen may facilitate the diagnosis of fungal endophthalmitis.