International Journal of Clinical Research
International Journal of Clinical Research. 2023; 7: (12) ; 10.12208/j.ijcr.20230355 .
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上海交通大学医学院附属第九人民医院眼科 上海
*通讯作者： 陆琳娜,单位：上海交通大学医学院附属第九人民医院眼科 上海；
患者女性，78岁，因左眼视物模糊伴眼红2周就诊于我院眼科。患者发病5周前因“胆囊结石合并肝外胆管结石”行I期“腹腔镜胆囊切除术”，4周前行II期“经内镜逆行胰胆管造影术”。眼科检查示双眼非肉芽肿性炎症伴致密性玻璃体炎，玻璃体切除术中发现双眼玻璃体和视网膜散在黄白色“茸球状”病灶及左眼伴视网膜裂孔，左眼房水及右眼玻璃体液宏基因检测均发现近平滑念珠菌，基于高龄、两次胆道手术史的高危因素、典型眼底表现及宏基因检测结果，该病例诊断为胆道术后所致的双眼内源性真菌性眼内炎。
The patient is a 78-year-old woman who complained of painless blurred vision and redness in the left eye for 2 weeks. Due to diagnosis of gallstones complicated with extrahepatic bile duct stones, she underwent a primary laparoscopic cholecystectomy and second endoscopic retrograde cholangiopancreatography 5 weeks and 4 weeks ahead of the onset of her ocular symptoms, respectively. Ocular examination revealed non granulomatous inflammation with dense vitritis of both eyes. Vitrectomy was performed and intraoperative findings included bilateral white-yellowish ball lesions in the vitreous and retina with retinal tear in the left eye. Next generation sequencing analysis of a vitreous sample of right eye and aqueous humor of left eye detected the candida parapsilosis. Based on clinical presentation, risk factors and examination findings, a diagnosis of bilateral endogenous fungal endophtalmitis associated with biliary tract post-operation was established.
[1] 李思莹, 刘艳秋, 李倩, 王聪, 彭晓燕. 输尿管镜碎石术后内源性真菌性眼内炎误诊为细菌性眼内炎一例[J]. 眼科. 2020;29(3):2.
[2] Chen KJ, Sun MH, Chen YP, Chen YH, Wang NK, Liu L, et al. Endogenous Fungal Endophthalmitis: Causative Organisms, Treatments, and Visual Outcomes. J Fungi (Basel). 2022;8(6).
[3] Corredores J, Hemo I, Jaouni T, Habot-Wilner Z, Kramer M, Shulman S, et al. Endogenous fungal endophthalmitis: risk factors, clinical course, and visual outcome in 13 patients. Int J Ophthalmol. 2021;14(1):97-105.
[4] 汪晓娟, 胡小凤, 朱丹, 陶勇. 眼内液G试验辅助诊断真菌性眼内炎一例[J]. 中华眼底病杂志. 2020;36(4):2.
[5] Govindaraju VK, Chao JT, Duvall ER, Baker NS, Fahey KM, Lee R, et al. Incidence of Endogenous Fungal Endophthalmitis in Screening Dilated Exams in Patients with Elevated Beta-D-Glucan Levels versus Positive Fungal Blood Cultures. Clinical ophthalmology (Auckland, NZ). 2022;16:2743-50.
[6] 郝昕蕾, 张依, 李雪杰, 金玮, 杨安怀. 二代测序技术在外源性眼内炎患者病原微生物检测中的应用[J]. 眼科新进展. 2021.
[7] 宁雅婷 张, 孙天舒, 徐英春. 近平滑念珠菌毒力调控和耐药机制研究进展[J]. 中国真菌学杂志. 2022;17(6): 522-8.
[8] Wang H, Chang Y, Zhang Y, Yang R, Shi H, Zhang M. Bilateral endogenous fungal endophthalmitis: A case report. Medicine (Baltimore). 2023;102(16): e33585.
[9] 张瑜, 袁晓玲, 马懿辰, 陆肇曾. 感染性眼内炎的诊断和治疗[J]. 上海医药. 2022;43(7):7.
[10] 周慧颖, 叶俊杰, 陈有信, 董方田. 真菌性眼内炎的手术治疗与病原学研究[J]. 中华眼科杂志. 2018;54(4):7.