면역저하환자에서 발생한 안와의 괴사근막염 2예
Two Cases of Periorbital Necrotizing Fasciitis in Immunocompromised Patients
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목적: 면역저하환자에서 안와주위에 발생한 괴사근막염 2예를 보고하고자 한다. 증례요약: (증례 1) 당뇨 및 간암 간절제술 과거력이 있는 55세 여자 환자가 4일 전부터 발생한 좌측 안와주위 부종을 주요 소견으로 내원하였다. 좌안 시력은 광각이 없었고, 홍반성 부종 및 검은색의 괴사 병변이 관찰되었다. 안와주위 괴사근막염으로 진단하여 항생제를 투여하고, 괴사조직제거술을 권유하였다. 타 병원에 전원한 후 눈확내용물제거술을 시행하였으며, K. pneumoniae가 배양되었다. (증례 2) 난소암 항암치료 과거력이 있는 56세 여자 환자가 3일 전부터 발생한 우측 안쪽눈구석 부위 통증 및 피부괴사를 주소로 내원하였다. 우안 시력은 부종으로 측정이 불가능하였다. 안와주위 괴사근막염을 진단하여 항생제를 투여하고 괴사조직제거술을 시행하였으며, P. aeruginosa가 배양되었다. 술 후 감염 진행 및 재발은 관찰되지 않았고, 우안 눈꺼풀재건술 이후 발생한 노출성 각막염으로 경과 관찰 중이다. 결론: 면역저하환자에서 안와주위 괴사근막염은 조기 발견과 치료가 중요하며, 적절한 항생제 치료 및 괴사조직제거술로 안와주위염증을 제거해 주는 것이 필요하다.
Abstract
Purpose: To report two cases of periorbital necrotizing fasciitis in immunocompromised patients. Case Summary: (Case 1) A 55-year-old female with a history of diabetes and hepatic liver resection visited our clinic complaining of periorbital edema in her left eye 4 days prior to her visit. The visual acuity of the left eye was no light perception. Erythematous edema of the periorbital area and a black necrotic lesion in the left eye were observed. Periorbital necrotizing fasciitis was diagnosed and broad-spectrum antibiotics were injected. Urgent debridement was recommended but the patient went to another hospital and orbital exenteration was performed. K. pneumoniae was isolated in her blood culture. (Case 2) A 56-year-old female with a history of ovarian cancer chemotherapy visited our clinic complaining of periorbital pain and skin necrosis in her right eye 3 days prior to her visit. The visual acuity of the right eye could not be measured because of severe lid edema. Periorbital necrotizing fasciitis was diagnosed and antibiotic injection and urgent debridement were performed. P. aeruginosa was isolated in her blood culture. Postoperative infection progression and recurrence were not observed and eyelid reconstruction was performed. Conclusions: Early detection and treatment of periorbital necrotizing fasciitis is important in immunocompromised patients. Proper antibiotic therapy and necrotic debridement are needed to remove the periorbital inflammation.
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