肝膿瘍を原発とした転移性眼内炎の1例

A case of endophthalmitis metastatic from liver abscess

（P−2-1）　64歳男性に高熱が突発し，肝膿瘍と診断された。複数の抗生物質の投与を受けた。熱発から3日後に両眼飛蚊症と左眼視力障害が生じ，その3日後に受診した。矯正視力は，右0.6，左手動弁であり，右眼に虹彩炎，左眼に強い眼内炎の所見があった。転移性眼内炎と診断し，抗生物質の点眠結膜下注射，全身投与を行い，左眼に2度の硝子体切除術を行ったが，眼球癆に至った。肝膿瘍からKlebsiella　pneumoniaeが同定された。肝膿瘍からの転移性眼内炎はグラム陰性菌によることが多く，早期診断と早期治療が必要なことを本例は示している。

A 64-year-old male developed high fever and was diagnosed as liver abscess. While under systemic treatment with antibiotics, he noted flying flies in both eyes and blurred vision in the left 3 days after onset of fever. His corrected visual acuity was 0.6 right and hand motion left. The right eye showed anterior uveitis and the left eye showed severe endophthalmitis, leading to the diagnosis of metastatic endophthalmitis. The left eye became phthisic in spite of vitrectomy repeated twice in addition to topical and systemic treatment with antibiotics. The right eye showed spontaneous improve-ment resulting in visual acuity of 1.0. Elebsiella pneumoniae was later isolated from aspirate of liver abscess. This case illustrates that endophthalmitis metastatic from liver abscess may be caused by gram-negative bacteria necessitating early diagnosis and treatment.