양안 시신경염으로 발현한 눈매독 1예
A Case of Ocular Syphilis Presenting as Bilateral Optic Neuritis
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목적: 양안의 시신경염 이외에 다른 증상이 없는 환자의 혈청학적 검사에서 매독으로 진단한 경우를 경험하였기에 이를 보고하고자한다. 증례요약: 25세 남자가 2주 전 급작스럽게 시작된 양안 시력저하를 주소로 내원하였다. 교정시력은 우안 0.7, 좌안 0.1이었고, 전안부는정상이었으며, 안저검사에서 양안 시신경유두부종이 관찰되었다. 좌안의 색각이 저하되었고, 시야검사에서 우안의 주변시야협착, 좌안의 전반적인 시야감소, 형광안저촬영에서 양안 시신경유두에서 형광누출이 있었다. 혈액검사에서 FTA-ABS IgM, IgG, RPR이 양성이고, 뇌척수액검사에서도 VDRL과 FTA-ABS IgG가 양성이어서 눈매독 진단하에 항생제 치료를 하였다. 치료 6달 후 교정시력은우안 1.0, 좌안 0.8이며, 안저검사에서 시신경유두는 정상이고, 시야검사와 빛간섭단층촬영에서도 호전되었다. 결론: 눈매독은 다른 안과적, 전신적 증상을 동반하지 않고 시신경염으로만 처음 나타날 수 있으므로, 매독에 대한 혈청학적 검사와적절한 항생제 치료가 필요하다.
Abstract
Purpose: To report a case of ocular syphilis presenting as bilateral optic neuritis. Case summary: A 25-year-old man presented with visual difficulty in both eyes that had begun 2 weeks previously. Best correctedvisual acuity was 0.7 in the right eye and 0.1 in the left eye. Anterior segment was normal. On fundoscopic examination,optic disc swelling was found in both eyes. Color vision was abnormal in the left eye. The visual field (VF) showed peripheral constrictionin the right eye and generalized reduction in the left eye. Fluorescein angiography revealed early, bilateral leakage ofdye from the optic disc with multiple hot spots in the chorioretinal level. Serology was positive for fluorescent treponemal antibodyabsorbance (FTA-ABS) IgM, IgG and rapid plasma reagin test. A test of the cerebrospinal fluid was positive for venerealdiseases research laboratory and FTA-ABS IgG. A diagnosis of syphilitic optic neuritis was made and the patient was treatedwith antibiotics. Six months later, visual acuity was 1.0 in the right eye and 0.8 in the left eye. There was no disc swelling on bothfundoscopy and optical coherence tomographs. VF also improved after treatment, with the restoration of central vision. Conclusions: Syphilis can present as optic neuritis. Clinicians should consider serologic examination for syphilis and then initiateappropriate antibiotic treatment.
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