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目的:报告诺卡式菌属感染引起的盘状角膜炎病例1例。方法:病例报告。结果:患者,男,13岁,无角膜接触镜使用史,在小溪里游泳后,右眼疼痛伴视力下降2wk。最佳矫正视力:右眼6/30(0.2)。检查发现角膜基质存在形态规则的旁中心盘状浸润伴炎症反应。角膜敏感度下降。最初角膜刮片镜检行革兰氏染色阴性,棘阿米巴角膜刮片和培养阴性。诊断为病毒性盘状角膜炎,给予口服阿昔洛韦和局部使用激素眼药水。2wk后患者视力恶化伴角膜损伤加重,再次角膜取材刮片行革兰氏染色提示诺卡式菌属感染,按经验局部给予3g/L加替沙星眼药水后,临床效果明显。治疗6mo后,视力达到6/6仅在角膜中心留有少量角膜混浊。结论:诺卡式菌属感染延误诊断可以导致病情恶化。如果采用正确的治疗,诺卡式菌属感染引起的角膜炎可以恢复良好,仅留少量瘢痕,获得较好的视力。
OBJECTIVE: To report a case of discitis keratitis caused by nociceptive infection. Methods: Case report. Results: The patient, male, 13 years old, had no history of contact lens use and had a 2wk reduction in right eye pain with decreased visual acuity after swimming in the stream. The best corrected visual acuity: right eye 6/30 (0.2). Check the corneal stroma found in the shape of the rules of the central disc infiltration with inflammatory reaction. Corneal sensitivity decreased. The initial corneal smear Gram stain Negative, Acanthamoeba keratitis and culture negative. Diagnosed with viral discoid keratitis, given oral acyclovir and topical use of hormonal eye drops. 2wk patients with visual acuity worsened corneal injury, and again corneal smear Gram stain smear prompted nociception, according to the experience of local administration of 3g / L gatifloxacin eye drops, the clinical effect is obvious. After 6 months of treatment, visual acuity reached 6/6, leaving only a small amount of corneal opacity in the center of the cornea. Conclusions: Delayed diagnosis of nociception can result in worsening of the disease. Corneal inflammation caused by nociceptosis can recover well with proper treatment, leaving only a small amount of scar and better vision.