A toxic ocular manifestation of chloramphenicol therapy; report of a case of optic neuritis.
A toxic ocular manifestation of chloramphenicol therapy; report of a case of optic neuritis.
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氯霉素治疗的毒性眼部表现；
DOI：
10.1016/0002-9394(57)91949-9
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发表时间：
1957
期刊：
影响因子：
--
通讯作者：
L. Janoff
中科院分区：
文献类型：
--
作者：
J. Cole;H. G. Cole;L. Janoff
一种有效而有用的药物的好名声正迅速被诸如此类关于其严重副作用的报道所玷污。毫无疑问，氯霉素挽救了许多人的生命。立克次体病、脑膜炎、细菌性心内膜炎和对其他抗生素耐药的严重感染对氯霉素有反应。因此，副作用的严重性并不能成为谴责这种药物的理由。与任何药物一样，应了解和预期所有可能的副作用，以便在造成不可逆损害之前停止治疗。最常报告的氯霉素毒性表现为再生障碍性贫血、过敏反应、皮疹和粘膜刺激。心理表现和感觉异常也被注意到。视神经炎，虽然显然是一种罕见的结果的毒性，值得一个突出的地方名单上已知的毒性表现的氯霉素，不仅因为它的严重性质，但因为其影响。由于很明显，视神经损伤是氯霉素的副作用，考虑所述的心理影响是否可能不是由中枢神经系统其他结构的类似损伤引起的可能是有用的。氯霉素在脑脊液中的浓度很高，几乎是血液中的一半。四环素类的其他抗生素不会出现如此高的浓度。在使用任何抗生素或抗生素组合的长期治疗中，经常检查血液是标准做法。除此之外，还应经常检查眼底。要记住眼底是一个有用的诊断区域。应考虑眼底可能显示毒性的最初体征。在氯霉素治疗的整个过程中，对一些病例进行常规检查，可以发现这是否有价值。无论如何，如果出现任何其他毒性症状，如皮疹，必须由眼科医生检查眼睛。根据报告的两个病例和我们的病例，氯霉素毒性的眼部症状是视力模糊、中央周围暗点和视野收缩。检眼镜检查的情况下，在这里报告显示水肿的视神经和扩张的静脉。Lasky、Pincus和Icatlan^报道了相同的发现，此外，眼底不同部位有许多血管扩张。Wallenstein和Snyder* 发现视神经充血，椎间盘边缘被神经纤维水肿所掩盖。维生素B12似乎已经纠正了氯霉素毒性带来的各种情况。在我们的病例中，在停用氯霉素并给予二甲双胍、维生素B12和氯化硫胺后，视神经炎减轻。在Lasky，Pincus和Katlan报告的病例中，病情更为严重;而贫血和皮疹则是并发症。
DISCUSSIONThe good name of a potent and useful drug is rapidly being tarnished by reports, such as this one, about its serious side effects. There is no question that chloram phenicol saves many lives. Rickettsial dis eases, meningitis, bacterial endocarditis, and serious infections resistant to other antibio tics have responded to chloramphenicol. The severity of the side effects, therefore, does not justify condemnation of the drug. As with any drug, all possible side effects should be understood and anticipated so that treatment may be discontinued before irreversible damage is done. The most frequently reported manifesta tions of chloramphenicol toxicity are aplas tic anemias, anaphylactic reactions, skin eruptions, and mucous membrane irritations. Psychologic manifestations and paresthesias have also been noted. Optic neuritis, though apparently a rare result of toxicity, deserves a prominent place on the list of known toxic manifestations of chloramphenicol not only because of its serious nature but because of the implications. Since it is obvious that optic-nerve damage is a side effect of chlor amphenicol, it might be useful to consider whether the psychologic effects noted may not be caused by similar damage to other structures of the central nervous system. The concentration of chloramphenicol in the cerebrospinal fluid is high, almost half that in the blood. Such a high concentration does not occur with other antibiotics of the tetra cycline class.In long-term treatment with any antibiotic or combination of antibiotics, frequent ex amination of the blood is standard practice. To this should be added frequent examina tion of the fundus. It is well to remember that the fundus is a useful diagnostic area. The possibility should be considered that the fundus may reveal the first signs of toxicity. Routine check throughout the course of chloramphenicol treatment in a number of cases should reveal whether this would be of value. At any rate, examination of the eyes by an ophthalmologist is mandatory if any other symptoms of toxicity, such as skin eruptions, appear. On the basis of the two cases reported, and our case, the ocular symptoms of chlor amphenicol toxicity are blurred vision, peri central scotoma, and constriction of the visual field. Ophthalmoscopic examination in the case reported here revealed edema of the optic nerve and dilation of the veins. Lasky, Pincus, and ICatlan^ reported the same findings and, in addition, numerous hemorrhages in various parts of the fundus. Wallenstein and Snyder* found hyperemia of the optic nerve and disc margins obscured by edema of the nerve fibers. Vitamin B12 appears to have corrected various conditions brought on by chloram phenicol toxicity. In our case, the optic neuritis was decreased after withdrawal of chloramphenicol and administration of Dia mox, Vitamin B12, and thiamine chloride. In the case reported by Lasky, Pincus, and Katlan, the condition was more advanced; while anemia and skin eruptions were cor-