虹彩面上白色塊を呈した真菌性眼内炎

Postoperative fungal endophthalmitis caused by Paecilomyces lilacinus

　術後真菌性眼内炎と考えられる1例を報告した．症例は52歳男性で緑内障手術の既往があり，虹彩面上に白色塊状物を認めた．前房穿刺液を培養して真菌が検出され，更に周辺虹彩切除術時に得られた虹彩の病理組織標本にて菌要素および菌糸が認められた．アンホテリシンBの局所投与および硝子体切除術とアンホテリシンBの硝子体内注入を行い眼内炎は消褪したが，視力は手動弁にとどまった．

　分離された真菌をPaecilomyces lilacinusと同定した．本菌株を培養し，酵母様形態を作成することに成功した．P．lilacinusは二形性真菌のひとつと考えられる．

A 52-year-old male had been treated by corneoscle-ral trephining surgery on account of iridocyclitis and glaucoma in his left eye 5 weeks before. The operated eye became increasingly dim and irritated so that he was referred to us.

On admission, multiple white exudates were seen on the iris associated with turbid aqueous and cata-ract in the left eye. Aspiration of the aqueous during therapeutic iridectomy showed fungi and no trace of bacteria. The patient was then treated by topical and subconjunctival amphotericin B, and later by vitrec-tomy with intravitreal amphotericin B. The visual acuity of the affected eye remained perception of hand movement due, apparently, to corneal opacity and extensive retinal atrophy.

The isolated fungus was identified as Paecilomyces lilacinus, which is a common saprophyte and an occa-sional pathogen. We could turn the isolated P. lila-cinus into a yeast-like form by incubation, which is a proof that this organism is one of potentially dimo-rphic fungi.