비장절제 환자에서 발생한 폐렴사슬알균 내인성 안내염: 증례보고

Abstract

Purpose: To report a case in which vitrectomy was performed for endogenous endophthalmitis caused by Streptococcus pneumoniae in a patient with a history of splenectomy, followed by multiple reoperations due to severe inflammation. Case summary: A 57-year-old man with a history of diabetes mellitus, bile duct cancer surgery, and splenectomy visited our hospital because of decreased visual acuity that had started one day earlier after treatment for a cold. During vitrectomy on the day of presentation, endophthalmitis was suspected, and intravitreal antibiotic injection was performed. However, secondary surgery was performed, including intravitreal antibiotic injection, due to hypopyon and inflammation that worsened after surgery. After that, iris synechia progressed, and retinal detachment was confirmed during the third operation, and silicone oil injection was performed. Streptococcus pneumoniae was identified in the vitreous humor culture obtained during the first operation. Oral steroids were administered after the first surgery, and inflammation was stabilized after the third surgery. Conclusions: Streptococcus pneumoniae may be suspected as the cause of endogenous endophthalmitis accompanied by spleen insufficiency. Endogenous pneumococcal endophthalmitis may experience more severe inflammation after surgery, and active surgical treatment and systemic use of steroids can help improve visual prognosis.