염증성안와질환에서 Rituximab의 치료 3예
Three Cases of Rituximab Treatment for Orbital Inflammatory Disease
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목적: 다른 치료에 잘 반응하지 않는 염증성안와질환에 Rituximab을 투여하여 치료한 3예를 보고하고자 한다. 증례요약: 스테로이드제, 안와방사선치료를 시행 받았으나 증세의 호전이 없었던 염증성안와질환 환자 3명(66세 갑상샘눈병증 환자,54세 외안근염 환자, 77세 특발성경화성안와염증 환자)에게 Rituximab을 투여하였다. Rituximab은 정맥주사로 1000 mg을 2주 간격으로 2회 투여하는 것을 1 cycle로 하였다. 갑상샘눈병증 환자는 압박시신경병증으로 Rituximab을 1 cycle 투여받았으며, 이후 시력,색각, 시유발전위, 시야검사에서 호전을 보였다. 외안근염 환자는 Rituximab을 2 cycle 투여 후 외안근의 염증성 비대 소견이 감소하였고 복시가 호전되었다. 특발성경화성안와염증 환자는 Rituximab을 1 cycle 투여 후 시력 및 시야검사에서 호전을 보였다. 3명 모두Rituximab 투여 후 호중구감소증 및 면역글로불린 감소 등의 혈액학적 변화는 없었으며 심각한 감염은 발생하지 않았다. 결론: 스테로이드 및 방사선 치료에 반응하지 않는 염증성안와질환에서 Rituximab은 고려해 볼 수 있는 치료법이다.
Abstract
Purpose: To report three cases of rituximab treatment in refractory orbital inflammatory disease. Case summary: Rituximab treatment was performed in three patients (thyroid-associated ophthalmopathy, orbital myositis,and idiopathic sclerosing inflammation) unresponsive to corticosteroid and radiotherapy. One cycle consisted of intravenous infusion of 1000 mg of rituximab, twice at a two-week interval. The patient with thyroid-associated ophthalmopathy exhibited clinical improvement in visual acuity, color vision, visual evoked potential, and visual field after one cycle of rituximab treatment. The patient with orbital myositis improved showed diplopia with a decrease in the size of the extraocular muscle after two cycles of treatment. The patient with idiopathic sclerosing inflammation showed improvements in visual acuity and visual field defect after one cycle of therapy. There were no severe infections or hematologic adverse effects including neutropenia, or decreased immunoglobulin during the follow-up period. Conclusions: Treatment with rituximab appears to offer another therapeutic option in patients unresponsive to corticosteroid or radiotherapy.
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