암포테리신, 포사코나졸 병용투여와 암포테리신 세척으로 치료한 비안와두부형 국균증 1예
Treatment of Rhino-Orbito-Cerebral Aspergillosis with Combination of Amphotericin, Posaconazole and Amphotericin Irrigation: A Case Report
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목적: 암포테리신 B, 포사코나졸의 병용투여와 암포테리신 세척으로 치료한 비안와두부형 국균증 1예를 보고하고자 한다. 증례요약: 당뇨가 있는 59세 남자 환자가 좌측 얼굴 감각이상, 통증을 주소로 본원 신경과에 입원하였고, 좌측 안구통증으로 안과에 의뢰되었다. 시력은 좌안 무광각이었고 안저검사에서 시신경유두부종과 앵두반점이 관찰되었다. 좌안이 우안보다 돌출되어 있었고, 좌측 완전 눈꺼풀처짐과 전체 눈근육마비가 관찰되었다. 안와 전산화단층촬영에서 좌측 상악동염, 사골동염이 관찰되어 코내시경 검사를 시행하였고, 중비갑개 근처에 검은색 괴사딱지가 관찰되어 시행한 조직검사에서 뮤코르진균증이 의심되었다. 이에 즉시 포사코나졸과 암포테리신 B를 병용투여하였다. 또한 좌측 내시경적 부비동 수술을 시행하였고 이어서 시행한 조직검사에서 국균증으로 확진되었다. 안와꼭지까지 캐뉼라를 삽입한 후 암포테리신 B로 5일간 세척하였다. 18개월째 환자는 생존하고 있는 상태이다. 결론: 안와내용물제거술을 거부한 국균증 환자에서 암포테리신, 포사코나졸의 병용투여와 캐뉼라를 이용한 안와꼭지의 암포테리신세척으로 좋은 치료 결과를 보여 보고하는 바이다.
Abstract
Purpose: To report a case of rhino-orbito-cerebral aspergillosis successfully treated with a combination of amphotericin B, posaconazole and amphotericin B irrigation. Case summary: A 59-year-old male with hypertension, diabetes mellitus and hyperlipidemia was admitted to our neurology department for left facial paresthesia, pain and consulted to ophthalmology for left eyeball pain. His visual acuity was no light perception in the left eye, and fundus examination showed papilledema and a cherry-red spot. Left exophthalmos and complete ptosis with ophthalmoplegia were also observed. Orbital computed tomography revealed left maxillary and ethmoid sinusitis, and nasal endoscopic examination revealed a black eschar adjacent to the middle turbinate. Subsequent biopsy suggested mucormycosis. The patient was immediately treated with a combination of amphotericin B and posaconazole. In addition, left endoscopic sinus surgery was performed and aspergillosis was histopathologically confirmed. The patient underwent amphotericin B irrigation for 5 days after canula insertion up to orbital apex. The patient survived for 18 months and is still alive. Conclusions: A combination of amphotericin B, posaconazole and amphotericin B irrigation using the canula through the orbital apex may be helpful in treating patients with rhino-orbito-cerebral aspergillosis who refuse orbital exenteration.
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