高毒力肺炎克雷伯菌引起的严重脓毒症致内源性眼内炎1例  

A case report of endogenous endophthalmitis result from severe hypervirulent Klebsiella pneumoniae sepsis

作　　者：叶晨安[1] 殷杏[2] 李敏[3] 陆晓晔[1] 刘黎[1] 王长生[1] 朱长清[1] 秦娟秀[3] 

机构地区：[1]上海交通大学医学院附属仁济医院急诊科,上海200127 [2]第二军医大学附属长征医院实验诊断科 [3]上海交通大学医学院附属仁济医院检验科

出　　处：《临床急诊杂志》2017年第5期395-398,共4页Journal of Clinical Emergency

摘　　要：随着近年来脓毒症逐渐被重视和研究,其并发症逐渐进入人们视野。内源性眼内炎（endogenous endophthalmitis,EE）常继发于未经治疗的严重菌血症,在所有眼内炎中仅占2~8%,在临床中容易被忽视。我科诊治了1例高毒力肺炎克雷伯菌引起的的严重脓毒症致内源性眼内炎,现总结报告如下。1病例资料患者,男,51岁。因＂发热、气促1周,视物模糊3d＂入院。Endogenous endophthalmitis is a rare and severe complication in sepsis with poor prognosis. Last year,a 51-years-old male admitted to our emergency department due to high fever, breathless and visual impair- ment. A clinical diagnosis of severe sepsis complicated with pneumonia, diabetes, thrombophlebitis and endoph- thalmitis was made based on clinical manifestations,laboratory data,imaging detection and ophthalmologic exami- nation. At the same time, hematogenous infection caused by a subtype of hypervirulent Klebsiella pneumoniae （HvKP） was identified by applying blood culture and molecular biology detection method. Besides, HvKP species bacteremia leaded to severe endogenous endophthalmitis and profound thrombocytopenia. However, most of the septic symptoms were improved due to evidence-based empiric antibiotic therapy except for the impaired vision. The patient and his family refused to accept either diagnostic vitrectomy or surgical intervention, and the patient discharged later. We recommend that emergency physicians should recognize the ocular symptoms result from se- vere sepsis,and keep awareness on the atypical clinical features in the earlier stage of the disease course, because prompt ophthalmologic diagnosis and managements may improve the outcome.

关 键 词：肺炎克雷伯菌 脓毒症 眼内炎 

分 类 号：R631[医药卫生—外科学]