[1]黄志翾,曾志冰,徐筑萍.抗生素过敏反应所致Purtscher样视网膜病变:1例报告及文献复习[J].南方医科大学学报,2018,(03):239.
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抗生素过敏反应所致Purtscher样视网膜病变:1例报告及文献复习()
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《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2018年03期
页码:
239
栏目:
出版日期:
2018-04-03

文章信息/Info

Title:
Purtscher-like retinopathy associated with antibiotic anaphylaxis
作者:
黄志翾曾志冰徐筑萍
关键词:
Purtscher-like视网膜病变Perstscher 视网膜病变过敏反应抗生素
Keywords:
Purtscher’s retinopathy Purtscher-like retinopathy antibiotic anaphylaxis
摘要:
本文报告1例由抗生素帕珠沙星过敏所致Purtscher样视网膜病变临床表现。患者18岁,因发热、寒颤和咽部疼痛予“帕珠 沙星”抗感染治疗后出现皮疹、瘙痒、全身水肿和视力下降,停药后病情仍持续加重。影像学检查显示:肺间质改变、心包积液、 腹腔积液和盆腔积液。双眼眼底为典型的Purtscher 样表现:黄斑和视盘周围大量棉绒般、视网膜Purtscher斑,视网膜水肿。经 过激素冲击治疗、抗过敏药物使用及全身支持治疗1月后,患者全身情况逐渐好转,但眼底缺血性改变继续加重,玻璃体腔注射 抗新生血管药物康柏西普2次仍迅速发展至双眼视网膜新生血管形成和玻璃体出血,进行玻璃体切除术后视力仍为光感。术 后随访2年视力无提高。Purtscher及Purtscher 样视网膜病变病因多样,患者视力受损程度差异大,眼底表现为典型的双眼对称 后极部散在视网膜棉絮斑、Purtscher斑、出血和水肿,眼底荧光血管造影表现为不同程度视网膜小动脉阻塞无灌注、后期荧光素 血管管壁渗漏和着染,Purtscher斑分布的相应区域为弱荧光。通常结合患者眼底表现、全身疾病及其病史作出诊断。发病机制 可能为各种原因的视网膜前小动脉阻塞。目前尚无治疗指南。激素治疗有争议,但若严重影响视力,应积极去除潜在全身病因, 必要时激素冲击治疗。严重病例谨防病情发展至视网膜新生血管和出血,需密切观察及时进行抗新生血管的预防和治疗。
Abstract:
We report a case of an 18-year-old woman with systemic antibiotic anaphylaxis who presented anasarca and bilateral visual loss two weeks after the intravenous use of pazufloxacin. Ancillary fundus tests revealed bilateral cotton-wool spots, Purtscher flecken, edema, and retinal arteriolar occlusion around the optic disc. After pulse corticosteroid, administration of anti- anaphylactic agent, and general support therapy for one month, the patient showed a favorable change, with the symptoms lessened or free systemically, except the continuous aggravation of fundus ischemic change. After two intravitreal injections of Ranibizumab, there were still a large area of capillary non-perfusion and neovacularizations in the binocular retina, resulting in vitreous hemorrhage. The patient’s visual acuity had still light perception after right-eye vitrectomy and presented no improvement during the postoperative follow-up of two years. Literature review revealed that there were many causes associated with Purtscher-like retinopathy, and the consequent visual impairment varied significantly. Prompt management of the underlying condition is crucial in giving the patient the best chance to restore vision.
更新日期/Last Update: 1900-01-01