新英格兰NEJM:眼前房出血

一33岁男性猪饲养员因双眼出现突发性双眼视模糊、疼痛、发红和畏光而就诊。患者有10天的持续高热史(39.4℃),全身不适和肌肉疼痛史。眼科检查示双侧虹膜睫状体炎(前葡萄膜炎)。泼尼松龙滴眼液和软膏等局部治疗后疼痛和畏光减轻,但第二天左眼前房出现和血(图A 3点示位置有一光反射区,图B 9点位置示前房部分有一明亮区)。实验室检查示γ-谷氨酰转移酶为129U/L (正常值<55U/L),丙氨酸氨基转移酶为49U/L (正常值<45U/L),白细胞计数为11700/ml (正常值范围为4400/ml-11300/ml)。临床和实验室检查结果提示诊断为钩端螺旋体病。血清学检查钩端螺旋体interrogans serovar serjoe的IgM和IgG抗体阳性。眼前房出血常因眼外伤引起,但是在极少数病例可引感染引起。经过持续的局部和系统阿莫西林治疗,患者的症状逐渐消退,2周内实验室检查和视力也恢复正常,前房出血和眼部发红也在1月内消失。



Hyphema


A 33-year-old man who was a pig farmer presented with sudden blurred vision, pain, redness, and photophobia in both eyes. He had a 10-day history of persistent fever (temperature, 39.4 C°), malaise, and myalgia. Ophthalmologic examination revealed bilateral iridocyclitis (anterior uveitis). Local treatment (prednisolone eyedrops and ointment and cyclopentolate eyedrops) alleviated the pain and photophobia overnight, but the next morning he had hyphema in his left eye (Panel A shows a view with the light-source reflection at the 3 o’clock position, and Panel B at the 9 o’clock position illuminating a section of the anterior chamber). Laboratory testing revealed a γ-glutamyltransferase level of 129 U per liter (normal value, <55), an alanine aminotransferase level of 49 U per liter (normal value, <45), and a white-cell count of 11,700 per cubic millimeter (normal range, 4400 to 11,300). Clinical and laboratory findings suggested a diagnosis of leptospirosis. Serologic tests revealed IgM and IgG antibodies against Leptospira interrogans serovar serjoe. Hyphema is usually caused by ocular trauma, but in rare cases, it can be a result of infection. With continued local treatment and the addition of systemic treatment with amoxicillin, the patient’s symptoms abated and his laboratory values and vision returned to normal within 2 weeks. The hyphema and eye redness resolved completely 1 month after their appearance.

原文链接:http://www.nejm.org/doi/full/10.1056/NEJMicm1108425

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