안와 및 두개내로 파급된 침윤성 국균증: 보리코나졸로 치료한 1예
A Case of Invasive Aspergillosis Involving the Orbital Apex and Occipital Lobe:Successful Treatment with Voriconazole
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목적: 접형골동에서 기시한 국균증이 안와 및 두개내로 파급되어 안구운동장애 및 시신경병증을 초래한 환자에서 수술적 치료 없이보리코나졸(Voriconazole) 치료 후 1년 이상의 추적관찰을 하고 있는 1예를 보고하고자 한다. 증례요약: 고혈압 외에 특이 병력 없이 지내던 74세 여자 환자가 4일 전부터 왼쪽 눈이 아프고 눈이 안 움직인다는 증상을 주소로 내원하였다. 뇌전산화단층촬영 및 자기공명영상에서 좌안 안와첨까지 파급된 좌측 접형골동염 의심되어 절제 생검술 시행 결과 국균증으로 진단되었다. 내원 당시 좌안 내사시, 안구운동장애, 구심성 동공장애, 안검하수 소견을 보였으며, 추적관찰하던 중 후두엽 뇌경색이발생하였다. 보리코나졸 주사 치료 후 안검하수 및 안구운동장애 소견이 호전되고 13개월간의 추적관찰 기간 동안 질병의 재발 없이생존하고 있으며, 현재 추적관찰 중이다. 결론: 매우 드물지만 면역능력이 정상인 환자에게서 부비동에서 기시한 국균증이 안와 및 두개내까지 파급될 수 있으며, 예후가 불량하다고 알려졌으나 보리코나졸 치료로 좋은 결과를 보였기에 보고하는 바이다.
Abstract
Purpose: To report an immunocompetent patient with more than 1-year survival after treatment with voriconazole, despite invasive paranasal sinus aspergillosis involving the orbital apex. Case summary: A 74-year-old woman with only preexisting hypertension visited our clinic complaining of pain and immovable left eye that occurred approximately 4 days prior. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a sphenoid sinusitis with suspicious lesion involving the orbital apex of the left eye. A biopsy by functional endoscopic sphenoid surgery (FESS) was performed through the sphenoid sinus, which enabled us to diagnose aspergillosis. The patient had esotropia, ophthalmoplegia, positive RAPD, and ptosis in the left eye. On follow-up, a new MRI showed acute to subacute stage infarction at the left occipital lobe. After the patient was treated with intravenous voriconazole,ptosis, and ophthalmoplegia improved. At the 13-month follow-up, she was alive with no disease recurrence. Conclusions: Invasive aspergillosis of orbit and cerebrum in healthy patients is a rare clinical entity. In case of central nervous system involvement, the survival outcome is poor with high mortality; however, good results can be obtained by treatment with voriconazole.
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