RESUMO
BACKGROUND: We report a case of fungal endophthalmitis which developed after subtenon injections of triamcinolone acetonide (TA). CASE: A 63-year-old man had Graves' ophthalmopathy. He had received subtenon injections of TA in his left eye. He was admitted to Kimura Eye & Internal Medicine Hospital because of a subconjunctival abscess with inflammatory cells in the anterior chamber. Although we treated it as a suspected bacterial infection at the first visit, it deteriorated rapidly. Because prolonged antibiotics and antifungal therapy seemed ineffective, we performed diagnostic surgery. The lower sclera around the subtenon injections of TA was hard and thick, and a white spotty lesion and retinal detachment were seen on the lower retina. A culture of the Tenon sac showed filamentous fungus. After the surgery the subconjunctival abscess recurred because intravenous antifungal therapy had been discontinued. A culture of the abscess identified Alternaria sp. The subconjunctival abscess, thickened sclera, and retinal exudate were limited to the region of the sub-Tenon injection of TA, We conclude that the sclera had been permeated by hyphae of Alternaria sp. CONCLUSION: In this case, critical infection was caused by the sub-Tenon injections of TA.
Assuntos
Endoftalmite/etiologia , Infecções Oculares Fúngicas/etiologia , Triancinolona Acetonida/administração & dosagem , Triancinolona Acetonida/efeitos adversos , Alternaria/isolamento & purificação , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/microbiologia , Oftalmopatia de Graves/tratamento farmacológico , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-IdadeRESUMO
UNLABELLED: A 6-week-old immunocompetent girl developed protein-losing gastroenteropathy (PLGE) and retinitis associated with cytomegalovirus (CMV) infection. At presentation, CMV antigenaemia (6 cells/46,000 white blood cells) and its DNA were detected in the patient's blood and in the mother's milk. Intravenous ganciclovir and gamma-globulin rapidly ameliorated all symptoms and CMV antigenaemia disappeared. No immunological defects were identified in this patient. To the best of our knowledge, this case involves the youngest known immunocompetent patient demonstrating CMV-induced PLGE and retinitis. CONCLUSION: breast-feeding by a cytomegalovirus-positive mother can be a primary cause of early onset cytomegalovirus infection in infants.
