신경매독과 연관되어 발생한 안매독의 임상 양상
Clinical Manifestations of Ocular Syphilis Combined with Neurosyphilis
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목적: 포도막염의 임상 양상으로 발현되어 안과 의사에 의해 처음 진단된 신경매독과 연관되어 발생한 안매독의 발생을 보고하고자한다. 대상과 방법: 2009년에서 2012년 사이에 삼차 의료 기관에서 발생한 안매독 환자 7명에 관한 후향적 연구이다. 결과: 환자들의 평균 연령은 44.4세(범위 33-71)였다. 모든 환자에서 후안부의 침범이 발견되었으며, 두 명은 유두염도 동반하였다. 혈청 검사에서 모든 환자들은 VDRL검사(Venereal Disease Research Laboraroy), 형광트레포네마항체흡수시험(FTA-ABS), 트레포네마 팔리둠혈구응집반응(TPHA)에서 양성 소견을 보였다. 형광 안저검사에서는 망막 혈관과 유두의 누출 소견이 가장 흔한 소견이었다. 6명의 환자에서 뇌척수액 검사가 행해졌으며, 모두 뇌척수액 형광트레포네마항체흡수시험과 트레포네마 팔리둠혈구응집반응에서양성 소견을 보였다. 뇌척수액의 VDRL검사는 두 명의 환자(33.3%)에서만 양성 소견이었다. 결론: 모든 안매독 환자는 뇌척수액의 형광트레포네마항체흡수시험과 트레포네마 팔리둠혈구응집반응에 의해 신경매독으로 진단되었다. 따라서 이 연구를 통해 안과 의사가 매독의 조기 진단과 치료에 중요한 역할을 한다는 것을 알 수 있다.
Abstract
Purpose: To report the manifestation of ocular syphilis combined with neurosyphilis in patients who present with uveitis clinicallyand are diagnosed initially by an ophthalmologist. Methods: This study is a retrospective, clinical investigation of seven male patients with ocular syphilis from a single tertiary centerbetween 2009 and 2012. Results: The average age of the patients at onset was 44.4 years (range, 33-71 years). Posterior segment involvement wasfound in all patients. Two patients had papillitis. In serologic testing, all patients had positive responses to Venereal DiseaseResearch Laboratory (VDRL), fluorescent treponemal antibody-absorption test (FTA-ABS) and Treponema pallidum hemagglutination(TPHA). In fluorescein angiography (FAG), retinal vascular and disc leakage was the most common finding. Cerebrospinal fluid (CSF) analysis was performed for six patients and demonstrated positive CSF FTA-ABS and CSF TPHAtests in all patients. CSF VDRL was reactive in 2 patients (33.3%). Conclusions: All patients with ocular syphilis were diagnosed with neurosyphilis based on the analysis of CSF with FTA-ABSand TPHA. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis.
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