肝切除術後真菌性眼内炎を併発した肝硬変合併肝細胞癌の１例

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  • A CASE OF HEPATOCELLULAR CARCINOMA WITH HEPATIC CIRRHOSIS ASSOCIATED WITH MYCOTIC ENDOPHTHALMITIS AFTER HEPATECTOMY

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We report a patient with hepatocellular carcinoma with hepatic cirrhosis who developed mycotic endophthalmitis after hepatectomy for which early administration of antimycotic drugs resulted in symptomatic remission.<br> A 68-year-old man was admitted to the hospital to undergo surgery for hepatocellular carcinoma. A central venous catheter was inserted and central venous nutrition was started on the 6th day before surgery, a subsegmentectomy of the liver being performed. Central venous nutrition was maintained after the operation because he could not eat well. The patient had a high fever, 39.5°C, on the 21st hospital day. Catheter fever was suspected and the catheter was removed. On the next day a decreasing tendency of fever was noted, but ocular symptoms such as dimming and ocular pain appeared. Mycotic endophthalmitis was suspected and intravenous administration of fluconazole 200mg was started on the same day. Ocular findings included bilateral conjunctival hyperemia, white exudative spots at the right fundus oculi, and deposits on the posterior aspect of the cornea, which suggested retinochorioditis but the vitreous bodies were normal. From these findings mycotic endophthalmitis was diagnosed. Continuous intravenous administration of fluconazole for 4 weeks resulted in improvement of both ophthalmic findings and subjective symptoms.

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