背景技术Parinaud眼腺综合征是一种与耳前相关的单侧肉芽肿性睑结膜炎,颌下,和颈淋巴结病。几种传染病可引起Parinaud眼腺综合征,通常有结膜入口。最常见的潜在病理是猫抓病,其次是眼腺形式的tularemia。诊断通常是一个严重的挑战,因为这些感染本身是罕见的。另一方面,Parinaud眼腺综合征可能是更常见疾病的罕见表现(例如,结核病,梅毒,腮腺炎,单纯疱疹和EB病毒,腺病毒,立克次体,孢子丝菌,衣原体感染)。案例报告我们介绍了一例66岁男性肉芽肿性结膜炎和同侧耳前,颌下,角膜浅层损伤后的上颈淋巴结病。尽管系统阿莫西林/克拉维酸和甲硝唑抗生素治疗在入院时立即开始,淋巴结的化脓需要手术引流。根据他的回忆(绵羊繁殖;在初次就诊前2天,一根树枝划伤了他的眼睛)和症状,人畜共患病,即眼腺体形式的tularemia,被怀疑,经验性环丙沙星治疗,病人康复了,没有后遗症。最终通过微凝集血清学测定确认了杜拉弗朗西丝菌感染。结论如果诊断为Parinaud眼腺综合征,并且猫抓热作为最常见的病因是不可能的,其他人畜共患病,尤其是眼腺体形式的兔热症,应该被怀疑。血清学是最常用的实验室诊断方法。经验性氟喹诺酮(环丙沙星)或氨基糖苷(庆大霉素或链霉素)抗生素治疗应在最轻微的怀疑眼腺性耳热病时立即开始。
BACKGROUND Parinaud oculoglandular syndrome is a unilateral granulomatous palpebral conjunctivitis associated with preauricular, submandibular, and cervical lymphadenopathies. Several infectious diseases can cause Parinaud oculoglandular syndrome, usually with a conjunctival entry. The most common underlying pathology is cat scratch disease, followed by the oculoglandular form of
tularemia. Diagnosis is usually a serious challenge as these infections are themselves rare. On the other hand, Parinaud oculoglandular syndrome may be a rare manifestation of more common disorders (eg, tuberculosis, syphilis, mumps, herpes simplex and Epstein-Barr virus, adenovirus, Rickettsia, Sporothrix, Chlamydia infections). CASE REPORT We present the case of a 66-year-old man with granulomatous conjunctivitis and ipsilateral preauricular, submandibular, and upper cervical lymphadenopathies following a superficial corneal injury. Although the systematic amoxicillin/clavulanic acid and metronidazole antibiotic therapy started immediately at admission, the suppuration of the lymph nodes required surgical drainage. Based on his anamnesis (sheep breeding; a twig scratching his eye 2 days before the initial attendance) and symptoms, a zoonosis, namely the oculoglandular form of
tularemia, was suspected, empiric ciprofloxacin therapy was administered, and the patient recovered without sequelae. The Francisella tularensis infection was eventually confirmed by microagglutination serologic assay. CONCLUSIONS If Parinaud oculoglandular syndrome is diagnosed and cat scratch fever as the most common etiology is not likely, other zoonoses, especially the oculoglandular form of
tularemia, should be suspected. Serology is the most common laboratory method of diagnosing
tularemia. Empiric fluoroquinolone (ciprofloxacin) or aminoglycoside (gentamicin or streptomycin) antibiotic therapy should be started immediately at the slightest suspicion of oculoglandular
tularemia.