초록 열기/닫기 버튼
목적: 접촉 맥락막박리와 장액망막박리를 동반한 감염공막염을 경험하였기에 이를 보고하고자 한다. 증례요약: 65세 여자가 1주 전부터 발생한 우안 충혈과 통증으로 내원하였다. 전방염증이 관찰되었고, 이전 익상편수술로 인한 공막 얇아짐 및 괴사 주위 결막 소실이 관찰되었다. 괴사성 공막염과 앞포도막염 진단하에 스테로이드 점안 및 복용을 시작하였다. 1주 후 공막부종, 충혈 증가와 맥락막박리가 관찰되었고, 감염공막염 의심하에 익상편수술 부위 배양검사 및 점안 항생제 치료를 시작하였으나 맥락막박리 진행과 장액망막박리가 악화되는 소견이 보였다. 배양검사에서 녹농균이 동정되어 piperacillin/tazobactam 점안항생제 및 cefepime 2 g을 정맥주사하였으나, 악화 양상을 보여 점안 항생제 침투를 높이기 위해 괴사조직제거술을 시행하였다. 이틀 후 감염이 조절되는 것으로 판단되어 전신 스테로이드를 추가하였고, 이후 호전 경과를 보였다. 결론: 심한 맥락막박리와 장액망막박리를 동반한 감염공막염에서 적절한 항생제 치료에 불응하는 경우 괴사조직제거 병합이 도움이 될 수 있으며, 감염 조절 후 전신 스테로이드 치료가 좋은 결과를 보였다.
Purpose: We report a case of infectious scleritis featuring kissing choroidal detachment and serous retinal detachment. Case summary: A 65-year-old female presented with ocular pain and hyperemia of the right eye 1 week in duration. Anterior chamber inflammation was evident. After pterygium excision, a thinned sclera and loss of conjunctiva around a necrotic lesion were observed. Necrotizing scleritis with anterior uveitis was diagnosed and topical and systemic steroids commenced. After 1 week, the scleral thickness increased, but conjunctival injection and choroidal detachment were newly noticed. Infectious scleritis was suspected and the pterygium excision site cultured. Although empirical antibiotics (fortified ceftazidime and tobramycin) were prescribed, the choroidal and serous retinal detachments became aggravated. Pseudomonas aeruginosa was identified on scleral culture, and topical piperacillin/tazobactam and systemic cefepime (2 g) commenced. Although the antibiotics were appropriate, the choroidal and serous retinal detachments became further aggravated. Necrotic tissue was subjected to surgical debridement. Two days later, the infectious signs had diminished and a systemic steroid was added. Over the next few weeks, all of the choroidal and serous retinal detachments, and the infectious signs, improved. Conclusions: Patients with infectious scleritis featuring severe choroidal detachment and serous retinal detachment resistant to appropriate antibiotics may require surgical debridement of necrotic tissue. After controlling the infectious signs, systemic steroids should be considered to ensure a good prognosis.
