| 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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| 引用本文： | 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, 38(3): 239 |
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| 作者姓名： | 黄志翾 曾志冰 徐筑萍 |
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| 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。
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Purtscher-like retinopathy associated with antibiotic anaphylaxis |
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| Abstract: | We report a case of an 18-year-old woman with systemic antibiotic anaphylaxis who presented anasarca and bilateralvisual 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 ofanti- anaphylactic agent, and general support therapy for one month, the patient showed a favorable change, with thesymptoms lessened or free systemically, except the continuous aggravation of fundus ischemic change. After two intravitrealinjections of Ranibizumab, there were still a large area of capillary non-perfusion and neovacularizations in the binocularretina, resulting in vitreous hemorrhage. The patient’s visual acuity had still light perception after right-eye vitrectomy andpresented no improvement during the postoperative follow-up of two years. Literature review revealed that there were manycauses associated with Purtscher-like retinopathy, and the consequent visual impairment varied significantly. Promptmanagement of the underlying condition is crucial in giving the patient the best chance to restore vision. |
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