背景:内源性念珠菌眼内炎(ECE)是一种罕见但危及视力的疾病。ECE患者出现各种临床体征和症状,这会使诊断复杂化.本报告的目的是证明治疗结果并诊断由眼内炎症引起的黄斑并发症。病例介绍:一名41岁女性,有急性间歇性卟啉病病史,左眼出现进行性视力丧失。左眼OCT显示与真菌病因一致的发现,从中心静脉导管收集的拭子的培养证实了这一点。静脉注射氟康唑治疗的结果不令人满意,病人反复发作卟啉症,提示全身抗真菌治疗的卟啉作用。反复玻璃体内注射两性霉素B导致炎性病变逐渐消退。然而,在OCT和OCTA扫描中,随访检查显示黄斑新生血管(MNV)活跃.患者给予玻璃体内贝伐单抗。在随访的第11个月,OCT和OCTA扫描显示明显的炎性病变消退,黄斑瘢痕,并且没有检测到MNV活性。结论:本案例强调了OCT和OCTA作为有价值的非侵入性成像技术对ECE的识别的重要性。对其临床过程的监测,和黄斑并发症的诊断。
Background: Endogenous Candida endophthalmitis (ECE) is a rare but sight-threatening disease. Patients with ECE present with various clinical signs and symptoms, which can complicate the diagnosis. The aim of this report was to demonstrate the outcomes of treatment and to diagnose macular complications caused by intraocular inflammation.
Case presentation: A 41-year-old woman with a history of acute intermittent porphyria presented with a progressive vision loss in her left eye. Left-eye OCT revealed findings consistent with a fungal etiology, which was confirmed by the culture of swabs collected from a central vein catheter. The outcomes of intravenous fluconazole treatment were not satisfactory, and the patient developed recurrent attacks of porphyria, suggesting a porphyrogenic effect of systemic antifungal therapy. Repeated intravitreal injections with amphotericin B led to a gradual regression of inflammatory lesions. However, follow-up examinations revealed active macular neovascularization (MNV) on both OCT and OCTA scans. The patient was administered intravitreal bevacizumab. At the 11th month of follow-up, OCT and OCTA scans showed significant inflammatory lesions regression with macula scarring, and no MNV activity was detected. Conclusions: This
case highlights the importance of OCT and OCTA as valuable noninvasive imaging techniques for the identification of ECE, the monitoring of its clinical course, and the diagnosis of macular complications.