범발성 혈관내 응고증 환자에서 발현된 양안 망막중심정맥폐쇄 1예
Bilateral Central Retinal Vein Occlusion in Patient with Disseminated Intravascular Coagulation
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목적: 파종성 혈관내 응고증 환자에서 양안의 망막중심정맥폐쇄 1예를 경험하였기에 보고하고자 한다. 증례요약: 임신유발성 혈전성 혈소판감소성 자반증의 과거력이 있는 33세 여자가 하루 전 갑작스럽게 발생한 양안의 시력 저하를 주소로 내원하여 안과에 의뢰되었다. 내원 당시 양안 최대 교정 시력은 각각 안전수지 30 cm이었으며 안저검사상 양안에 망막중심정맥폐쇄 소견을 보이고 있었다. 검사실 소견상 혈전성 혈소판 감소증에 병발된 범발성 혈관내 응고증에 합당한 소견을 보이고 있어 혈장교환술, 신선동결혈장 및 동결침전제제수혈을 받았다. 이후에도 안저소견은 호전되지 않았고, 2주 동안의 내과적 치료에도 불구하고 대사성 산증으로 결국 사망하였다. 결론: 본 증례는 기존 혈전성 혈소판감소성 자반증이 악화되어 범발성 혈관내 응고증으로 진행하며 양안에 동시에 발생한 망막중심정맥폐쇄로서, 양안에 동시에 망막중심정맥폐쇄가 발생한 경우 기존질환의 악화 및 전신상태의 악화를 염두에 둔 적극적인 상태평가의중요성을 상기시켜 주는 좋은 예라 하겠다.
Abstract
Purpose: To report a case of bilateral central retinal vein occlusion (CRVO) as one of the initial signs of disseminated intravascular coagulation (DIC). Case summary: A 33-year-old woman with a history of pregnancy-induced thrombotic thrombocytopenic purpura presented to our hospital with bilateral visual loss. On her initial visit, visual acuity was counting fingers at 30 cm in both eyes. Based on the findings of a funduscopic examination, the patient was diagnosed with bilateral CRVO. Laboratory tests confirmed the diagnosis of DIC combined with thrombotic thrombocytopenic purpura (TTP). Plasma exchange and transfusion of cryoprecipitate with fresh frozen plasma was performed. The ocular fundus findings did not improve. Despite medical treatment, the patient’s systemic condition deteriorated and she died of metabolic acidosis two weeks later. Conclusions: Bilateral central retinal vein occlusion occurred as a sign of aggravation of preexisting TTP and progression to DIC in the presented case. In patients with severe bilateral retinal venous changes, there should be a very high level of suspicion for presence or progression of systemic disease, with the possibility of effective early systemic evaluation and therapy.
참고문헌 (11)
- Levi M, "Disseminated intravascular coagulation", Crit Care Med, 35, pp.2191~2195 (2007)
- Lewis K, "Severe ocular involvement in disseminated intravascular coagulation complicating meningococcaemia", Graefes Arch Clin Exp Ophthalmol, 243, pp.1096~1070 (2005)
- Samples JR, "Ocular involvement in disseminated intravascular coagulation", Ophthalmology, 90, pp.914~916 (1983)
- Lertsumitkul S, "Ocular manifestations of disseminated intravascular coagulation in a patient with the acquired immunodeficiency syndrome", Arch Ophthalmol, 115, pp.676~677 (1997)
- Lahey JM, "Laboratory evaluation of hypercoagulable states in patients with central retinal vein occlusion who are less than 56 years of age", Ophthalmology, 109, pp.126~131 (2002)
- Prisco D, "Retinal vein thrombosis risk factors, pathogenesis and therapeutic approach", Pathophysiol Haemost Thromb, 32, pp.308~311 (2002)
- Schneider M, "Thrombotic microangiopathy advances in differentiation and diagnosis", Clin Lab Sci, 20, pp.216~220 (2007)
- Shappell KK, "Meningococcemia with vitreous opacities: endophthalmitis or vitreous hemorrhage", Arch Ophthalmol, 117, pp.268~269 (1999)
- Delaey C, "Regulatory mechanisms in the retinal and choroidal circulation", Ophthalmic Res, 32, pp.249~256 (2000)
- Casares PZ, "Bilateral simultaneous central retinal vein occlusion (CRVO) caused by waldenstrom's macroglobulinaemia with acquired von willebrand's disease", Br J Haematol, 118, pp.344~347 (2002)
- 김상혁, "원발성 항인지질증후군에서 발생한 양안의 망막중심정맥폐쇄", 대한안과학회지, 48(10), pp.1433~1437 (2007), 대한안과학회