급성골수구성백혈병에서 재발의 첫 임상증상으로 나타난 시신경유두 침범의 1예
Leukemic Infiltration of the Optic Nerve Head as the Initial Manifestation of Leukemic Relapse
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목적: 급성골수구성백혈병 환자에서 재발의 첫 임상증상으로 나타난 시신경유두 침범의 1예를 보고하고자 한다. 증례요약: 급성골수구성백혈병으로 진단받고 항암치료 후 완전관해를 보이던 65세 여자환자가 갑작스런 좌안 시력저하를 주소로 내원 하였다. 안저소견에서 좌안의 시신경유두부종 및 시신경유두부 출혈, 황반부를 침범한 장액성 망막박리 소견을 보였다. 지속적인 시력 저하 및 안저소견 악화로 입원 15일째 대용량 스테로이드요법을 시행하였으나, 오히려 시력은 안전수지 10 cm로 급격히 저하되고 안저소견에서도 장액성 망막박리의 호전만 있을 뿐 시신경유두부종 및 유두부위 출혈은 더욱 악화되었다. 중추신경계 침범 검사는 모두 정상이었으나, 임상소견상 시신경으로의 백혈병성 침윤을 의심 하에 경막내 항암화학요법 및 방사선요법을 시행하였다. 입원 2개월 후 형태학적으로 병변은 호전되었으나, 시신경위축 소견을 보이고 시력은 회복되지 않았다. 결론: 본 증례는 중추신경계 침범이 드문 급성골수구성백혈병에서 재발의 단독 장소로 시신경유두를 침범하고, 이전에 보고된 치료법 에도 불구하고 오히려 급속히 진행되는 비전형적인 경과를 보여준 경우이다.
Abstract
Purpose: To present a case of leukemic infiltration of the optic nerve head as the initial manifestation of leukemic relapse. Case summary: A 65-year-old woman was diagnosed with acute myeloid leukemia. Complete remission was achieved after 4 complete courses of chemotherapy. She complained of a sudden decrease in visual acuity in her left eye. Fundus examination showed severe optic disc edema with peripapillary hemorrhage and serous retinal detachment. Visual acuity and fundus continued to aggravate and high-dose intravenous steroid therapy was instituted. Visual acuity and fundus deteriorated more after treatment. Brain magnetic resonance imaging and CSF study were normal but intrathecal chemotherapy and focal irradiation were performed on account of the suspected CNS involvement of leukemia. Morphologic improvement in the retinal structure was achieved, however, optic atrophy remained and her vision did not recover. Conclusions: The present case shows the involvement of the optic nerve head as the initial isolated manifestation for the relapse in a patient with complete remission. CNS involvement is rare in acute myeloid leukemia and in particular, the optic nerve is rarely reported as the initial isolated presentation for the relapse. Moreover, the disease progression relatively aggravated after treatment. In the atypical aspects of leukemic relapse, the present case was noticeable.
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