猴痘病毒感染致角膜炎1例  

A case of monkeypox-associated keratitis

作　　者：杨宇婧 张朝然 YANG Yujing;ZHANG Chaoran(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2025年第S1期15-18,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：37岁男性,因“左眼肿胀、眼红、畏光伴视力下降1个月”就诊,眼部检查:左眼上睑水肿,眶上缘外侧扪及肿块,结膜充血水肿,角膜缘膜状分泌物黏附,角膜上皮大片缺损、基质水肿。结膜分泌物培养、角膜刮片镜检及微生物培养、活体共聚焦显微镜检查均未发现细菌、真菌或阿米巴。眼眶CT示:左眼睑肿厚,泪腺弥漫性肿大。予更昔洛韦滴眼液、环孢素滴眼液、妥布霉素地塞米松滴眼液等局部治疗,病情短暂好转后出现反复。予角膜缘清创并取分泌物及邻近结膜组织送宏基因组高通量测序(又称下一代测序技术),测得猴痘病毒DNA序列数207429,后经疾病控制中心确诊为猴痘病毒感染。患眼予聚维酮碘滴眼液、妥布霉素地塞米松滴眼液治疗后逐渐好转。1个月后,患者再次出现左眼眼红、畏光不适,查体见左眼上睑肿胀、角膜下方上皮树枝状上皮缺损及基质水肿。予更昔洛韦滴眼液、环孢素滴眼液治疗,角膜上皮缺损面积不断增大、浅层基质溃疡,视力进行性下降。行左眼羊膜移植手术,术中取部分角膜病灶组织再次送宏基因组高通量测序,测得猴痘病毒DNA序列数8071。予聚维酮碘滴眼液、环孢素滴眼液、氟米龙滴眼液局部滴眼,术后3个月,眼表基本稳定,角膜上皮愈合、基质白斑形成,周边新生血管长入。末次随访为术后7个月,未见复发。讨论体会:猴痘病毒引起的角膜炎罕见,缺乏特征性临床表现,对于常规抗病毒治疗无效的角结膜炎患者,应仔细询问病史、寻找眼外表现,宏基因组高通量测序有助于明确诊断。A 37-year-old male patient presented with left eye redness,photophobia,and blurred vision for one month.Ophthalmic examination revealed prominent swelling of the left upper eyelid,diffuse conjunctival injection,and membranous discharge on the corneal limbus.Extensive corneal epithelial defect with stromal edema were observed.Corneal and conjunctival swabs were sent for bacterial and fungal cultures,no organisms were identified.Confocal microscopy examination revealed abundant inflammatory cells infiltration,but no fungal hyphae or amoebae were detected.Orbital CT revealed left eyelid thickening and diffuse enlargement of the lacrimal gland.The patient was treated with topical ganciclovir,cyclosporine and tobramycin-dexamethasone.The condition improved briefly but relapsed soon.Debridement of the corneal limbus was performed,and secretions and adjacent conjunctival tissues were taken for metagenomic highthroughput sequencing(also known as next-generation sequencing,NGS),and monkeypox virus infection was highly suggested with a DNA-sequences count of 207429,and was confirmed subsequently by the Centers for Disease Control.Topical povidone-iodine was added to the regimen for the affected eye,and the ocular surface inflammation gradually resolved.One month later,the patient returned with a recurrence of redness,photophobia,and discomfort in the left eye.Left upper eyelid swelling,dendritic corneal ulceration and stromal edema were observed during physical examination of the left eye.Topical ganciclovir,cyclosporine,and fluorometholone were administered,but ulceration continued to worsen with enlarging corneal epithelial defects and progressive vision loss.He underwent an amniotic membrane transplantation on the left eye,together with a corneal biopsy.The specimen sent for mNGS again revealed a sequence count of 8071 for monkeypox virus DNA.After three-month readmission of povidone-iodine,cyclosporine,and fluorometholone topically,the ocular surface was basically stable,the corneal epithelium healed,stromal leukoma fo

关 键 词：猴痘病毒 角膜炎 眼部感染 宏基因组高通量测序 

分 类 号：S85[农业科学—兽医学]