Curtobacterium pusillum에 의한 개방안구손상 후 안내염

Endophthalmitis Caused by Curtobacterium pusillum Following Open Globe Injury

목적: 개방안구손상 후 급성 안내염이 발병하고 광범위한 망막정맥염과 이차 망막하신생혈관이 합병된 Curtobacterium 안내염 1예를 경험하였기에 최초로 보고하고자 한다. 증례요약: 베타락탐계 항생제에 과민반응이 있는 53세 남자가 농촌 지역에서 안외상 후 발생한 시력저하로 전원되었다. 좌안 전층각막열상과 외상성 백내장으로 안저검사가 불가능하였다. 일차봉합술 및 수정체제거술 후, 유리체절제술 도중 유기물이 황반부에서 관찰되었다. 유기물 아래의 망막은 창백하였고 광범위한 망막정맥염이 관찰되어, 급성 세균성 안내염으로 의심하고 유리체강내 vancomycin과 dexamethasone을 주사하였다. 배양 결과 Curtobacterium pusillum이 동정되어 2주간 vancomycin을 정주하고 clarithromycin을 복용하였다. 3개월 후 안내염은 재발하지 않았지만 유기물에 손상된 부위에 망막하신생혈관이 합병되었다. 6개월 후 신생혈관에 의한 합병증은 관찰되지 않았다. 결론: 농촌 지역의 개방안구손상은 Curtobacterium과 같은 드문 그람양성간균에 의한 급성 안내염을 유발할 수 있으며 광범위한 망막정맥염과 이차 망막하신생혈관이 합병될 수 있다.

Purpose: To report the first case of Curtobacterium endophthalmitis within 6 hours after open globe injury, with extensive phlebitis and secondary subretinal neovascularization. Case summary: A 53-year-old man with hypersensitivity to beta-lactam antibiotics was admitted due to visual disturbance in the left eye experienced while working in a rural area. Fundus examination was impossible due to a full-layer corneal laceration and traumatic cataract in the left eye. B-scan ultrasonography and orbital computed tomography showed no shadowing of retained intraocular foreign bodies. After a corneal scraping smear, primary closure, lensectomy, and vitrectomy were performed. Organic material was observed in a focal area of pale macula, accompanied by extensive retinal phlebitis in the mid-periphery. After diagnosing acute bacterial endophthalmitis, intravitreal vancomycin and dexamethasone were injected. Curtobacterium pusillum was cultured on an automated microbial identification system. Intravenous vancomycin and oral clarithromycin were administered for 2 weeks. After 3 months, endophthalmitis had not recurred, and the visual acuity reached 20/100. However, subretinal neovascularization was newly detected under the damaged macula. No complications of neovascularization were observed until 6 months after primary closure. Conclusions: Curtobacterium pusillum can induce acute endophthalmitis through direct penetration in cases of ocular trauma, and may be accompanied by extensive phlebitis and secondary subretinal neovascularization. In cases of open globe injury sustained in rural areas, acute endophthalmitis caused by a rare Gram-positive bacillus, such as Curtobacterium species, should be considered.