Talaromyces allahabadensis에 의한 진균각막궤양
A Fungal Corneal Ulcer Caused by Talaromyces allahabadensis
조용운 ( Cho Yong-Wun ) - Gyeongsang National University College of Medicine Department of Ophthalmology
변정현 ( Byun Jung-Hyun ) - Gyeongsang National University College of Medicine Department of Laboratory Medicine
강현지 ( Kang Hyun-Ji ) - Gyeongsang National University College of Medicine Department of Ophthalmology
유웅선 ( Yoo Woong-Sun ) - Gyeongsang National University College of Medicine Department of Ophthalmology
서성욱 ( Seo Seong-Wook ) - Gyeongsang National University College of Medicine Department of Ophthalmology
김성재 ( Kim Seong-Jae ) - Gyeongsang National University College of Medicine Department of Ophthalmology
Abstract
목적: Talaromyces allahabadensis에 의한 각막궤양환자를 체험하였기에 보고하고자 한다.
증례요약: 69세 남자 환자가 좌안의 충혈 및 통증으로 약 2달 전부터 개인병원 안과에서 결막염 및 주변부 헤르페스각막염으로 치료를 받았으나 호전이 없어 본원으로 전원되었다. 환자는 약 2달 전에 감나무에 좌안을 수상한 적이 있으며, 내원 당시 전안부검사상 주변부 각막상피결손 및 기질침윤과 병변 주위에 심한 각막부종이 관찰되었다. 각막찰과표본으로 그람염색, KOH 도말 및 배양검사에서는 음성이었으며, 임상적으로 헤르페스각막염으로 진단하고 항바이러스제와 경험적 항생제를 사용하였다. 호전과 악화를 반복하였으나, 2주째부터는 기질침윤이 증가하여 그람염색, KOH 도말 및 배양검사를 다시 시행하였으며, 배양검사에서 Talaromyces allahabadensis가 검출되었다. 항진균제를 추가하고, 각막 천공위험이 있어 결막판이식술을 시행하였으며, 이후 각막염은 호전 소견을 보였다.
결론: 외상 이후 헤르페스각막염으로 치료를 받던 환자에서 Talaromyces allahabadensis에 의한 각막궤양을 진단하고 항진균제와 결막판이식술로 성공적인 치료를 하였다.
Purpose: Here, we report a case of a fungal corneal ulcer caused by Talaromyces allahabadensis (T. allahabadensis).
Case summary: A 69-year-old male was admitted to our hospital with pain and hyperemia in his left eye after 2 months of treatment at a local clinic for herpetic keratitis. The patient had a previous history of trauma to his left eye caused by a persimmon tree branch. He had a peripheral epithelial defect, stromal infiltration, and severe corneal edema in his left eye. Gram staining, a KOH smear, and a culture were performed using corneal specimens; the results were all negative. With the assumption of herpetic keratitis, antiviral and empirical antibiotic treatments were started. After 2 weeks, the stromal infiltrations on his left eye increased, so we again conducted staining and culture studies. T. allahabadensis was isolated from a specimen, so treatment was started using antifungal agents, and a conjunctival flap graft was performed due to the risk of a corneal perforation.
Conclusions: A case of corneal ulcer caused by T. allahabadensis in a patient with posttraumatic herpetic keratitis was successfully treated with antifungal agents and conjunctival flap surgery.
키워드
Corneal ulcer; Fungal keratitis; Talaromyces allahabadensis; Trauma
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