Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
권호 표지

Fungal Keratitis Caused by Chromomycetes

Chromomycetes 에 의한 진균성 각막염

Kim, Yun-Sang;Song, Young-Soo;Kim, Jae-Chan
김윤상;송영수;김재찬

  • Published : 20030300
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Abstract

Purpose: Chromomycetes is a plant parasite and one of the pigmented filamentous fungi, which rarely causes human infection. The authors report the first case of fungal keratitis caused by chromomycetes in korea. Methods: A 65-year-old woman developed pain, redness, and an yellowish-brown infiltrate in her right eye. She had a history of corneal scratch by a pumpkin stalk and transferred by a local clinic after management for about 1 months. The clinical features suggested fungal keratitis, and the patient was undertaken surgical debridement with amniotic membrane graft and treated with oral terbinafine with natamycin and amphotericin B eyedrops. Surgically taken biopsy specimen was cultured. Amniotic membrane was removed after 1 week. After slight improvement of symptom, necrotizing ulceration was enlarged in spite of continuous antifungal therapy. Lamellar keratoplasty with amniotic membrane graft was done with antifungal therapy. Systemic agent was changed to fluconazole. Clinical improvement was achieved after about 2 months. The fungus was identified as Fonsecaea pedrosoi. Results: Fungal keratitis was successfully treated with antifungal medication combined with amniotic membrane graft. Conclusions: This is a rare case of infectious keratitis caused by chromomycetes. But its clinical course was severe, so exact culture and identification following aggressive surgical and medical treatment was needed.

목적 : Chromomycetes는 식물의 표면에 흔히 기생하는 사상성 진균의 하나이나, 인체 감염은 잘 일으키지 않는 것으로 알려져 있다. 국내에서는 아직 보고되지 않은, 상기 균으로 인한 각막염 1예를 보고하고자 한다. 대상과 방법 : 65세 여자환자가 우안의 안통과 충혈 및 황갈색의 궤양을 주소로 내원하였다. 농사일을 하다가 호박넝쿨의 솜털에 찔린 뒤 발생한 각막궤양으로 타 병원에서 1개월 여 치료받다 전원되었다. 진균성 각막염을 의심하여 세밀하게 괴사조직 절제를 시행하고 양막이식술을 시행한 뒤 Natamycin과 Amphotericin B를 점안하고, Terbinafine을 경구투여하기 시작하였다. 절제된 조직은 배양하였다. 술 후 1주 경 임시이식 된 양막을 제거하고 지속적으로 항진균제치료를 시행하였으나 일시적 증상호전 후 궤양이 다시 증가하며 영구이식된 양막조직을 괴사시켰다. 층판각막이식술과 양막이식술을 시행하고 경구투여 항진균제를 Fluconazole로 교체하였으며 지속적인 항진균제 점안한 결과 약 2개월 만에 임상양상이 호전되었다. 동정 결과 Fonsecaea pedrosoi를 확진하였다. 결과 : 항진균제와 양막이식술을 병용하여 진균성 각막염을 성공적으로 치료하였다. 결론 : 상기 균이 비록 인체감염은 잘 일으키지 않으나 일단 감염되면 난치성 각막염의 임상적 경과를 밟으므로 적극적인 치료를 요한다.

Keywords

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