방사상각막신경염의 임상양상을 보인 에로모나스 = Radial Keratoneuritis in Aeromonas Keratitis

다국어 초록 (Multilingual Abstract)

Purpose: We report a case of Aeromonas keratitis presenting as radial keratoneuritis.
Case summary: A 33-year-old woman with a history of cleaning her contact lenses with tap water presented with decreased visual acuity for 1 day in the left eye. The patient showed diffuse corneal edema, stromal infiltration, and radial keratoneuritis, which were thought to be pathognomonic for Acanthamoeba keratitis. Based on the patient’s clinical findings and past history, a diagnosis of Acanthamoeba keratitis was made and she was prescribed topical fortified cefazolin (50 mg/mL, 5%), tobramycin (3 mg/mL), and 0.02% chlorhexidine per hour. Culture results from the contact lens and contact lens solution confirmed infection by Aeromonas hydrophilia. Polymerase chain reaction results for Acanthamoeba were negative. After 8 days of treatment, the uncorrected visual acuity was 0.7/0.3 with improvement in her corneal findings.
Conclusions: Radial keratoneuritis is not always pathognomic for Acanthamoeba keratitis and can be present in Aeromonas keratitis. Therefore, ophthalmologists should be cautious when interpreting this clinical sign.

국문 초록 (Abstract)

목적: 방사상각막신경염의 임상양상을 보인 에로모나스 각막염 1예를 보고하고자 한다.
증례요약: 33세 여자환자가 내원 1일 전부터 시작된 좌안의 시력 저하를 주소로 내원하였다. 환자는 콘택트렌즈를 수돗물로 세척하여 사용하고 있었다. 전안부검사상 미만성 각막부종, 기질침윤 및 아메바성 각막염의 특징적인 징후인 방사상각막신경염 소견이 관찰되었다. 환자의 임상양상과 과거력을 바탕으로 가시아메바 각막염 의심하에 5% fortified cefazoline (50 mg/mL), tobramycin (3 mg/mL)과 0.02% chlorhexidine을 1시간 간격으로 점안하였다. 콘택트렌즈와 콘택트렌즈 세척액의 배양검사상 Aeromonas hydrophilia가 동정되었다. 중합효소 연쇄 반응(polymerase chain reaction) 검사상 Acanthamoeba는 동정되지 않았다. 치료 8일 후 시력은 0.7/0.3이었으며 각막염은 호전되었다.
결론: 방사상각막신경염이 항상 아메바성 각막염에서만 관찰되는 특징적인 임상양상은 아니며, 에로모나스 각막염에서도 나타날 수 있다. 그러므로 임상 결과를 해석할 때 주의가 필요하다.

참고문헌 (Reference)

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