시신경주위염으로 발현된 사르코이드증
Optic Perineuritis as a Presenting Sign of Sarcoidosis
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목적: 시신경주위염으로 발현된 사르코이드증을 보고하고자 한다. 증례요약: 57세 남자가 2주 전 시작된 좌안 시력저하를 주소로 내원하였다. 환자는 1년 6개월 전 무증상 좌측 시신경주위염으로 한 달간 경구 프레드니솔론을 복용한 후 호전된 병력이 있었다. 이번에는 눈운동 시 좌안 통증을 호소하였고, 좌안 교정시력은 20/50으로 저하되었으며 좌안에 색각이상과 상대구심동공운동장애가 관찰되었다. 전안부검사에서 특이 소견은 없었다. 안저검사에서 좌안시신경부종이 확인되었고, 안와자기공명영상에서 좌측 시신경주위의 조영증강 소견이 관찰되었다. 혈액검사에서 호산구양이온단백과 안지오텐신전환효소가 상승하였으며 흉부 방사선검사에서 양측 폐문림프절 비대가 확인되었다. 기관지 내시경을 이용한 조직검사상비건락성 육아종성 염증이 관찰되었으며 항산균 염색은 음성이었다. 이에 사르코이드증 진단하 경정맥 고용량 메틸프레드니솔론 투여 후 경구 프레드니솔론을 6개월간 서서히 감량하며 투여하여 좌안 시력은 호전되었다. 결론: 사르코이드증과 관련된 증상으로 시신경주위염이 발생할 수 있으며, 다른 전신 증상이 나타나기 전 초기 증상으로 발현할 수 있으므로 감별이 필요하다.
Abstract
Purpose: To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. Conclusions: Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.
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