장기간 예방적 경구 항생제를 이용한 재발성 톡소플라즈마 망막염 치료
Recurrent Toxoplasma Retinitis Treated with Long-Term Oral Antibiotics
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목적: 장기간 저용량 항생제를 사용하여 재발하는 톡소플라즈마 망막염의 재활성화를 억제하였기에 보고하는 바이다. 증례요약: 76세 여자 환자가 우안 시력저하 및 비문증을 주소로 내원하였다. 교정시력은 0.3, 망막에 노란 침윤성 병변 및 해당 부위의 형광안저촬영상 누출, 혈액검사상 톡소플라즈마 면역글로불린 G가 검출되어 톡소플라즈마 망막염 진단하에 경구 트리메토프림-설파메톡사졸, 클린다마이신 및 경구 스테로이드를 투여하여 호전되었다. 5개월 후 시력저하 및 염증 재발 소견으로 경구 스테로이드를 투약하고 호전되었다. 전신 스테로이드에 대한 부작용으로 유리체내 덱사메타손 이식제 주입으로 대체하였다. 초기에는 염증이 감소하였지만 2개월 후 악화되는 양상으로 재감염에 대한 치료를 위해 항생제를 다시 투여하였다. 잔여 유리체혼탁 제거를 위한 유리체절제술 후 안정적인 경과를 보여 항생제를 중단하였으나, 염증 재활성화 소견을 보여 저용량 항생제 복용을 다시 시작하고 5개월간 유지하였다. 이후 망막 상태는 염증 없이 안정적으로 유지되었다. 결론: 반복적으로 재발하는 톡소플라즈마 망막염 증례에서 장기간 저용량 경구 항생제 투약이 감염의 재활성화를 예방하는 데 도움이 될 수 있다.
Abstract
Purpose: The purpose of this case was to report the inhibition of toxoplasma retinitis reactivation with long-term, low-dose antibiotics. Case summary: A 76-year-old woman complained of poor vision and floaters in her right eye. The corrected visual acuity (LogMAR) of the right eye was 0.5, and there was an area of yellow infiltration and dye leakage on the retinal fluorescein angiography images. Toxoplasma IgG were detected in the serum, the patient was diagnosed with toxoplasma retinitis, and the patient was advised oral trimethoprim-sulfamethoxazole, clindamycin, and steroids. Her visual acuity improved and the inflammation resolved. However, she again had decreased visual activity and retinal inflammation in her right eye after 5 months. The inflammation improved with oral steroids, but she was shifted to intravitreal dexamethasone because of the side effects of systemic steroids. Although the inflammation improved initially, there was worsening of inflammation (evidenced by vitreous opacity) after 2 months, which was treated with oral antibiotics. After vitrectomy for the removal of residual vitreous opacity, antibiotics were stopped because of the stable disease course. After discontinuation of the antibiotics, inflammation was noted again, and low-dose trimethoprim-sulfamethoxazole was administered. Low-dose antibiotics were continued for 5 months and the disease remained stable without any retinal inflammation. Conclusions: Long-term, low-dose oral antibiotics may prevent reactivation of recurrent toxoplasma retinitis.
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