薬物治療が著効した進行性真菌性眼内炎の1例

Systemic antifungal medication was effective in a case of bilateral advanced fungal endophthalmitis

　71歳の女性が1週間前からの両眼視力障害で受診した。糖尿病が21年前からあり，胃癌手術に続発した腸閉塞のために3か月前から静脈内高栄養輸液（IVH）を受けていた。18日前に敗血症と肺炎が発症した。尿から真菌，喀痰から緑膿菌とMRSAが検出されていた。矯正視力は右0.04，左0.01で，両眼眼底に白色斑が播種状に分布し，真菌性眼内炎と診断した。全身状態が不良なため，フルコナゾールを1日量200mgで点滴した。10日後に眼内炎は軽快をはじめ，6週後には寛解した。最終視力として，右0.6，左指数弁となった。進行性の真菌性眼内炎に薬物療法が有効である場合があることを示す症例である。

A 71-year-old diabetic female presented with bilateral blurring since one week before. She had been receiving intravenous hyperalimentation (IVH) for ileus secondary to surgery for gastic cancer. Septicemia and pneumonia had developed 18 days before. Fungus had been isolated from the urine and pseudomonas aeruginosa and methicillin-resistant staphylococcus aureus from the sputum. Her visual acuity was 0.04 right and 0.01 left. White masses were present in both fundus with vitreous opacity, leading to the diagnosis of fungal endophthalmitis. As vitreous surgery was contraindicated because of her poor general condition, she was given fluconazol at the daily doses of 200 mg. The endophthalmitis started to subside 10 days later and resolved after 6 weeks. Her final visual acuity was 0.6 right and counting fingers left. This case illustrates that systemic medication alone may induce resolution of fungal endophthalmitis.