Aspergillus nigerによる内因性真菌性眼内炎の1例

A case of endogenous fungal endophthalmitis caused by Aspergillus niger

　43歳女性が胆嚢疾患で開腹手術を受け，術後に経静脈高栄養輸液が行われた。術後3週に熱発があり，播種性血管内凝固症候群DICが発症した。両眼の飛蚊症のため，術33日後に眼科に紹介された。眼底には後極部を中心に黄白色の滲出斑があり，真菌性眼内炎が疑われた。抗真菌剤は右眼に対しては無効であり，眼科初診から45日後に硝子体手術が行われた。採取した硝子体からAspergillus nigerが分離された。術後の経過は良好で，病巣は瘢痕治癒した。本症例は，真菌性眼内炎が抗真菌剤に反応しない場合には，良好な視機能転帰と病原体を同定するために，早期の硝子体手術が必要であることを示している。

A 43 - year- old female underwent abdominal surgery for gallbladder problems. Intravenous hyperalimentation therapy was performed following surgery. Three weeks after surgery, she developed fever and disseminated intravascular coagulation syndrome (DIC) . She was referred to us on day 33 of surgery for bilateral myodesopsia. Funduscopy showed white masses in the posterior fundus in both eyes, leading to the tentative diagnosis of fungal endophthalmitis. Treatment with systemic antifangal agents was futile for the right eye necessitating vitreous surgery 45 days after first seen by us. The surgically obtained vitreous sample showed Aspergillus niger. The postoperative course was uneventful resulting in scarring of the lesion. This case illustrates the necessity of early vitreous surgery for better visual outcome and identification of the causative organism when the ocular lesion does not respond to systemic antifungal agents.