반복된 단순포진 각막염의 반흔에 발생한 포마 그로메라타 진균각막염 1예

Title
반복된 단순포진 각막염의 반흔에 발생한 포마 그로메라타 진균각막염 1예
Other Titles
A Case of Phoma glomerata Keratitis Occurred in Recurrent Herpes Simplex Keratitis Cicatrix
Authors
전종화류남희장성동Jong Hwa JunNam Hee RyooSung Dong Chang
Keimyung Author(s)
전종화; 장성동; 류남희
Department
Dept. of Ophthalmology (안과학); Dept. of Laboratory Medicine (진단검사의학)
Keywords
Cicatrix; Herpes simplex; Keratitis; Phoma glomerata; Recurrent
Issue Date
2014
Publisher
School of Medicine
Citation
대한안과학회지, Vol.55(8) : 1229-1232, 2014
Abstract
Purpose: To report a case of Phoma glomerata keratitis occurring in recurrent herpes simplex keratitis cicatrix. Case summary: A 63-year-old male patient was admitted to our hospital with complaints of abrupt visual deterioration and ocular pain in his left eye. He was treated for recurrent herpes simplex keratitis in the same eye 12 years prior. Because central desmatocele was observed as a result of advanced corneal stromal melting, Gram staining, Potassium Hydroxide (KOH) mount, and culture were performed in corneal scrape specimens. On microbiological evaluation, a Phoma species was detected and Phoma glomerata was diagnosed using DNA sequencing method. Two consecutive amniotic membrane transplantations were performed with topical antifungal agents. The lesion was not improved when using topical amphotericin B and natamycin eyedrops, thus fluconazole eyedrops were used additionally. The corneal infection was resolved with central thick opacification. Conclusions: In the present case, herpetic keratitis was the main underlying causative factor because the patient had no past history of trauma. When diverse appearances of keratitis occur in herpes simplex keratitis patients, clinicians need to consider the concurrence of fungal infection, especially Phoma glomerata, a rare fungal organism.
목적: 반복된 단순포진각막염 후 각막반흔에 발생한 Phoma glomerata 진균각막염 1예를 경험하고 이를 보고하고자 한다. 증례요약: 좌안에 반복된 단순포진각막염으로 치료받던 63세 남자환자가 1주 전부터 발생한 좌안의 급격한 시력저하와 안통으로 내원 하였다. 세극등현미경검사상 각막기질융해가 급격히 진행되어 각막의 하이측부에 원형의 깊은 고랑이 발생하였고 그 중심부에는 데 스메막류가 관찰되었다. 각막찰과표본의 그람 염색, KOH 도말 검사 및 배양검사를 시행하였고 배양검사상 Phoma 균종이 의심되었 다. DNA sequencing 검사법상 Phoma glomerata로 확진되었으나 환자는 각막천공에 의해 2차례 양막이식술을 시행 받았고 natamycin 점안 항균제를 사용하면서 amphotericin B와 fluconazole 점안 항균제를 추가로 사용한 끝에 병변은 호전되었다. 결론: 본 증례는 외상의 과거력이 없어 단순포진각막염의 기저질환이 주요 발병요인으로 생각한다. 단순포진각막염 환자에서 기존과 다른 양상의 각막염이 발생할 경우 진균각막염의 병발 가능성을 생각하여야 하며 Phoma glomerata와 같은 드문 균주에 의한 기회감 염도 고려하여야 한다.
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/22202
ISSN
0378-6471
Appears in Collections:
1. 연구논문 > 1. School of Medicine (의과대학) > Dept. of Ophthalmology (안과학)
1. 연구논문 > 1. School of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학)
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