Voriconazole로 치료한 침습성 아스페르길루스부비동염 1예
Invasive Aspergillosis of the Paranasal Sinuses Invading Skull Base : Successful Treatment with Voriconazole
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초록
두개저를 침범한 침습성 아스페르길루스증은 드물지만 이환되었을 경우 사망률이 높은 심각한 질환이다. 하지만, 임상양상이 비 특이적이기 때문이 진단이 쉽지 않고, 치료 방법이 명확하게 확립되어 있지 않다. 제 2형 당뇨병력이 있는 52세 여자 환자가 우안 시력 저하 및 우측 안구통 주소로 내원하였다. 뇌 자기공명영상 촬영에서 부비동-안와를 포함하고 두개저까지 침범한 병변을 확인하였고 치료 및 진단적 수술을 통해서 침습성 아스페르길루스증을 진단하였다. 진단 후 amphotericin B로 치료를 시작하였으나 치료 반응이 좋지 않아 voriconazole로 치료 약제를 변경하였다. Voriconazole은 1일 째에 300 mg씩 2회 부하 용량으로 정맥 투여한 후, 총 7주간 200 mg씩 1일 2회 정맥 투여 하고, 이어서 총 7주간 200 mg씩 1일 2회 경구 투여하였다. 뇌 자기공명영상으로 치료 반응을 추적 관찰하였으며, 치료 종료 1년 후까지 추적한 결과 임상 소견 및 영상 검사 결과 모두 호전된 것을 확인하였다. 당뇨 환자에서 발생한 두개저를 침범한 침습성 아스페르길루스증에 대해서 종괴에 대한 조대술(marsupialization) 후 voriconazole 3개월 치료로 완치를 보인 증례를 문헌고찰과 함께 보고하는 바이다.
Abstract
Skull base-invading, invasive aspergillosis is rare, but it is a potentially life-threatening disease. Nevertheless, the standard method and the optimal duration of treatment are not known yet. A 52-year-old female diabetic patient complained of ophthalmalgia and decreased visual acuity. MRI and CT scan revealed an enhancing mass in the right orbital fissure and showed an infiltrating process in the skull base around the right orbit apex and paranasal sinuses. The histological investigation revealed invasive aspergillosis of paranasal sinuses and the skull base. Clinical improvement occurred after marsupialization and post-operative systemic antifungal therapy with voriconazole for 14 weeks. We suggest that voriconazole treatment could show effective results for invasive aspergillosis of skull base and paranasal sinuses.
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