결핵 뱀모양 맥락막염 환자에서 항결핵제와 스테로이드 치료 후에도 급격히 진행된 중심와 위축
Rapidly Progressing Foveal Atrophy with Tuberculous Serpiginous-Like Choroiditis Despite Combined Anti-Tuberculosis and Steroid Treatment
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목적: 결핵 뱀모양 맥락막염 환자에서 항결핵제와 스테로이드의 병합치료에도 불구하고 급격히 진행된 중심와 위축을 보이는 1예를경험하였기에 이를 보고하고자 한다. 증례요약: 54세 여자환자가 3일동안의 좌안 시력 저하를 호소하였다. 당시 좌안 시력은 안전수동이었으며 안저 검사상 좌안에서 시신경유두 부종과 후극부에서 노란 맥락망막의 병변이 관찰되었다. 빛간섭단층촬영에서 좌안 황반부위에 망막내 부종 및 망막하액이 보였다. 형광안저혈관조영술에서 초기엔 저형광이었으나 후기에는 과형광으로 나타났다. 인도시아닌그린혈관조영술에서는 초기 및 후기에서 저형광으로 나타나 시행한 인터페론 감마 분비검사법에서 양성소견을 보였다. 항결핵제와 스테로이드 병합요법을 시작 후 시신경유두 부종이 감소했으나, 발병 2주 후 빛간섭단층촬영에서 급격히 진행된 중심와의 위축이 보였다. 12주 후 최대 교정시력은 안전수지10 cm였으며, 6개월 후 최대교정시력 및 중심와의 위축은 변화가 없었다. 결론: 초기에 중심와를 침범한 결핵에 의한 뱀모양 맥락막염은 급격히 진행하여 2주내 중심와의 위축이 보이며 나쁜 시력예후를 보였다.
Abstract
Purpose: To report a case of rapidly progressing foveal atrophy with tuberculous serpiginous-like choroiditis. Case summary: A 54-year-old female patient had decreased vision of hand motions (os) for 3 days. Fundus examination showed optic disc swelling and yellowish chorioretinal lesions in the posterior pole (os). Optical coherence tomography (OCT) showed intraretinal edema and subretinal fluid in the left macula. Routine laboratory tests, serologic tests, and magnetic resonance imaging results were normal except for erythrocyte sedimentation rate (28 mm/hr). Fluorescein angiography showed the chorioretinal lesions appeared to be early hypofluorescence followed by late hyperfluorescence. Indocyanine green angiography showed hypofluorescence during early and late phases and the result of interferon-gamma release assay was positive. Under diagnosis of tuberculous serpiginous-like choroiditis, anti-tuberculous therapy combined with systemic corticosteroid was started. Despite decreased optic disc swelling, OCT showed a rapid progression of foveal atrophy within 2 weeks. Twelve weeks later, visual acuity was finger count at 10 cm. Six months later, best-corrected visual acuity and foveal atrophy were no interval change. Conclusions: Tuberculous serpiginous-like choroiditis with foveal involvement can show rapidly progressive foveal atrophy and poor visual prognosis.
참고문헌 (15)
- Tabbara KF, "Tuberculosis", Curr Opin Ophthalmol, 18, pp.493~501 (2007)
- Sheu SJ, "Ocular manifestations of tuberculosis", Ophthalmology, 108, pp.1580~1585 (2001)
- Gupta A, "Ocular signs predictive of tubercular uveitis", Am J Ophthalmol, 149, pp.562~570 (2010)
- Sarvananthan N, "Intraocular tuberculosis without detectable systemic infection", Arch Ophthalmol, 116, pp.1386~1388 (1998)
- Hong JW, "A case of tuberculous neuroretinitis", J Korean Opthalmol Soc, 46, pp.1582~1585 (2005)
- Song JS, "Ocular manifestations of systemic tuberculosis : report of 3 cases", J Korean Opthalmol Soc, 37, pp.1561~1569 (1996)
- Lim WK, "Serpiginous choroiditis", Surv Ophthalmol, 50, pp.231~244 (2005)
- Gupta V, "Presumed tubercular serpiginous like choroiditis: clinical presentations and management", Opthalmology, 110, pp.1744~1749 (2003)
- Vasconcelos-Santos DV, "Clinical features of tuberculous serpiginouslike choroiditis in contrast to classic serpiginous choroiditis", Arch Ophthalmol, 128, pp.853~858 (2010)
- Bansal R, "Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoid choroiditis", Ophthalmology, 119, pp.2334~2342 (2012)
- Mackensen F, "QuantiFERON TBGold-- a new test strengthening long suspected tuberculous involvement in serpiginous-like choroiditis", Am J Ophthalmol, 146, pp.761~766 (2008)
- Kang YA, "Discrepancy between the tuberculin skin test and the whole blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis- burden country", JAMA, 293, pp.2756~2761 (2005)
- Suzuki J, "Comparison of patients with ocular tuberculosis in the1990s and the 2000s", Jpn J Ophthalmol, 54, pp.19~23 (2010)
- Gupta V, "Successful management of tubercular subretinal granulomas", Ocul Immunol Inflamm, 14, pp.35~40 (2006)
- Gupta V, "Continuous progression of tubercular serpiginous-like choroiditis after initiating antituberculosis treatment", Am J Ophthalmol, 152, pp.857e2~863e2 (2011)