면역 결핍 상태가 아닌 당뇨 환자에서의 거대세포바이러스망막염
Cytomegalovirus Retinitis in Immunocompetent Patients with Diabetes Mellitus
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목적: 면역 결핍 상태가 아닌 당뇨 환자에서 거대세포바이러스망막염이 합병된 5예를 보고하고자 한다. 대상과 방법: 면역 결핍 상태가 아니면서 당뇨가 있던 환자에게서 거대세포바이러스망막염이 발생한 5례의 의무기록을 후향적으로 분석하였다. 모든 환자들은 당뇨가 있었고, 다양한 정도의 당뇨망막병증이 관찰되었으며, 망막병증 진단 시에 환자의 면역 상태를 확인하기 위해 장기 이식 등의 과거력과 면역억제제를 포함한 약물 복용력을 확인하고 피검사를 포함한 전신적 검사를 시행하여 면역저하가 없음을 확인하였다. 거대세포망막염이 의심되었던 5명의 환자들 모두에게 전방천자를 통한 viral polymerase chain reaction (PCR) 검사를 시행하였으며, 거대세포바이러스가 검출되었다. 5명 모두 전방천자를 통한 PCR 검사를 반복해 바이러스에 음성이 나올 때까지 유리체강내 항바이러스 주입술 치료를 받았다. 결과: 면역 결핍 상태가 아니지만 거대세포바이러스망막염이 발병한 환자들에서 공통적으로 15년 이상의 당뇨 유병 기간을 가지고 있었으며 평균 유병 기간은 17.4 ± 2.4 (15-20)년, 진단 시의 평균 당화혈색소는 7.3 ± 0.5 (6.8-8.0)%였다. 유리체강내 항바이러스제 치료 기간은 평균 23.8 ± 8.5 (14-36)개월이었으며, 주사 횟수는 14.8 ± 3.2 (10-18)회였다. 결론: 면역 결핍 상태가 아닌 당뇨 환자에서 거대세포바이러스망막염이 합병되어 이를 보고하고자 한다.
Abstract
Purpose: We report five cases of cytomegalovirus (CMV) retinitis in immunocompetent patients with diabetes mellitus (DM). Methods: This was a retrospective observational case series of five immunocompetent patients with CMV retinitis. All patients had DM and variable degrees of DM retinopathy. After discovery of the retinitis, we assessed the patients in terms of ophthalmologic history, systemic conditions, underlying disease, and the medications used for treatment, such as immunosuppressants. This was followed by blood and immunology tests. None of the five patients were immunocompromised. We confirmed the diagnosis of CMV retinitis by polymerase chain reaction (PCR) analysis; samples were collected by anterior chamber paracentesis. All patients were treated with intravitreal antiviral injection until negative results were obtained for the anterior chamber PCR. Results: All five immunocompetent patients who had developed CMV retinitis, had a history of diabetes of at least 15 years. The average duration of diabetes was 17.4 ± 2.4 (15-20) years, the average HbA1c was 7.3 ± 0.5% (6.8-8.0%), and the average duration and numbers of Intravitreal antiviral injections were 23.8 ± 8.5 months (14-36 months) and 14.8 ± 3.2 times (10-18 times), respectively. Conclusions: We report this case series because CMV retinitis can be complicated even in diabetic patients shown to be immunocompetent.
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