移植角膜に発症したAlternariaによる角膜真菌症

Keratomycosis due to Alternaria alternata

　全層角膜移植術を行い経過良好であった53歳農婦の移植角膜の一部に潰瘍の形成をみた．潰瘍辺縁組織のスメアー中に真菌の菌要素を認め，培養により，Alternaria alternataが分離同定された．チメロサール点眼，ピマリシン眼軟膏点入，フルシトシン（以下5-FC）内服により約2カ月で瘢痕治癒した．潰瘍は終始移植角膜内にとどまり，隣接した自己角膜に及ぶことはなかった．5種の薬剤の抗菌価（μg／ml）は次の通りであった．チメロサール0.0063，ピマリシン2，アンホテリシンB3.1，ナイスタチン6.3,5-FC100．

　Alternariaは腐生菌であり，健常結膜嚢からも分離されるが，感染症を起こすことは稀である．現在までに21例（内本邦2例）の報告があり，それらを含めて考察した．

A 53-year-old female developed light pain and blurred vision in her pseudophakic right eye. Pene-trating keratoplasty had been performed 5 months before for bullous keratopathy of that eye with gratifying results.

She manifested hypopyon as well as ulcer in the transplanted corneal graft. Many fungal elementswere observed in the smear of the ulcerated tissue, and an Alternaria alternata was cultured. The cor-neal lesion improved and resulted in scarred cure after two months treated with topical pimarcin and thimerosal, and systemic 5-fluorocytoninen (5-FC).As a particular clinical feature, the ulcer remained in the donor cornea without invading the host cor-nea throughout the course. The isolated strain showed following MIC values : thimerosal 0.0063, pimaricin 2.0, amphotericin B 3.2, nystacin 6.3, and 5-FC 100.0 yg/ml each.

Alternaria is a saprophyte and is non-pathogenicunder normal conditions. A total of 21 cases of Alternaria infection have so far reported. Our case happens to be the third one in Japan.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(3) : 225-229, 1987